Provider Demographics
NPI:1225469323
Name:BRISTOL, WILLIAM (RN)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 HUNTERS PARK LN
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7680
Mailing Address - Country:US
Mailing Address - Phone:407-854-8775
Mailing Address - Fax:
Practice Address - Street 1:4108 HUNTERS PARK LN
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7680
Practice Address - Country:US
Practice Address - Phone:407-854-8775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9174542163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse