Individual provider · Type 1 NPI

Tina Patrice Bristol

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Jacksonville, FL

NPI number 1346994845 Active

Practice location

4455 Ish Brant Rd W
Jacksonville, FL 32210-7046

Call (904) 377-6612 Map

Specialties and licenses

TaxonomyCodeLicense
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility Primary 320900000X016780800 (FL)

Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility: A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.

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About NPI 1346994845

Tina Patrice Bristol's National Provider Identifier is 1346994845, issued on Feb 4, 2022. The primary taxonomy on file is Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (320900000X), and the practice location is in Jacksonville, FL. The record was last updated on Feb 4, 2022.