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Mrs. Tina Patrice Bristol
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Jacksonville, Florida
NPI 1346994845

Tina Patrice Bristol is a Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility based in Jacksonville, FL. Tina Patrice Bristol practices in Jacksonville, FL. The NPI Number for Tina Patrice Bristol is 1346994845 and holds a License No. 016780800 (Florida).

The current practice location address for Tina Patrice Bristol is 4455 Ish Brant Rd W, Jacksonville, FL and can be reached out via phone at 904-377-6612.

Location: 4455 Ish Brant Rd W, Jacksonville, FL, 32210-7046
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1346994845
Provider Name
Tina Patrice Bristol
Credential
Provider Entity Type
Individual
Gender
Female
Address
4455 Ish Brant Rd W, Jacksonville, FL, 32210-7046
Phone Number
904-377-6612
Fax Number
Provider Enumeration Date
02/04/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
B62381764947-0 05 FL
016780800 05 FL
institution
Provider Business Practice Location Address Details
Address
4455 Ish Brant Rd W
City
Jacksonville
State
Florida
Zip
32210-7046
Phone Number
904-377-6612
Fax Number
person
Provider Business Mailing Address Details
Address
4455 Ish Brant Rd W
City
Jacksonville
State
Florida
Zip
32210-7046
Phone Number
904-377-6612
Fax Number
person
Provider's Taxonomy Details 1
Type
Residential Treatment Facilities
Classification
Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Speciality
-
Taxonomy
320900000X
License No.
016780800 (Florida)
Definition
A home-like residential facility providing habilitation, support and monitoring services to individuals diagnosed with intellectual and/or developmental disabilities.
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