Provider Demographics
NPI:1447626015
Name:GRIMALDO, TRISTAN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:TRISTAN
Middle Name:
Last Name:GRIMALDO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9190 KATY FWY STE 101
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7440
Mailing Address - Country:US
Mailing Address - Phone:832-358-8600
Mailing Address - Fax:832-358-0376
Practice Address - Street 1:9190 KATY FWY STE 101
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7440
Practice Address - Country:US
Practice Address - Phone:832-358-8600
Practice Address - Fax:832-358-0376
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128681363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily