Provider Demographics
NPI:1437301496
Name:BRISTOL, CONNIE LOU (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:LOU
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 COWAN HWY
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37398
Mailing Address - Country:US
Mailing Address - Phone:931-967-1514
Mailing Address - Fax:931-962-4081
Practice Address - Street 1:2204 COWAN HWY
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398
Practice Address - Country:US
Practice Address - Phone:931-967-1514
Practice Address - Fax:931-962-4081
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000013680363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily