Bristol, Tina Patrice

Bristol, Tina Patrice is an sole proprietor health care provider with primary practice located at 4455 Ish Brant Rd W , Jacksonville FL 32210-7046. She recently has only one registered license in Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities, which is considered as her primary health care specialty. Bristol, Tina Patrice can be contacted via phone (904) 377-6612.

Contact Information

Primary practice address
4455 Ish Brant Rd W Jacksonville FL 32210-7046
Phone: (904) 377-6612
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Residential Treatment Facilities / Community Based Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities 320900000X 016780800 Florida

Profile Details

NPI number 1346994845
LBN Legal business name Bristol, Tina Patrice
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Feb 4th, 2022
Last updated Feb 4th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1346994845 NPPES
Florida MEDICAID B62381764947-0
Florida MEDICAID 016780800

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