Provider Demographics
NPI:1821562901
Name:BRISTOL, LAUREN RAE HUDSON (NP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:RAE HUDSON
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 DONELSON PIKE STE B17
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37217-3015
Mailing Address - Country:US
Mailing Address - Phone:615-610-4523
Mailing Address - Fax:
Practice Address - Street 1:1015 HANSON CT STE 101
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-2765
Practice Address - Country:US
Practice Address - Phone:615-203-0566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN160411163W00000X
TN25113363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse