Provider Demographics
NPI:1164511341
Name:BRISTOL, DEBRA (APRN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:BRISTOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:976 MOUNTAIN CITY HWY
Mailing Address - Street 2:
Mailing Address - City:ELKO
Mailing Address - State:NV
Mailing Address - Zip Code:89801-2728
Mailing Address - Country:US
Mailing Address - Phone:775-777-7587
Mailing Address - Fax:775-738-9584
Practice Address - Street 1:1250 S CLEARVIEW AVE
Practice Address - Street 2:100
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3378
Practice Address - Country:US
Practice Address - Phone:480-423-4670
Practice Address - Fax:480-654-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN00276363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2407009Medicaid
NV103937Medicare PIN
NVS33303Medicare UPIN