Provider Demographics
NPI:1205127479
Name:BRISTOL, LEEANNA (APN)
Entity type:Individual
Prefix:
First Name:LEEANNA
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2874 N CARSON STREET
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89706-1682
Mailing Address - Country:US
Mailing Address - Phone:775-445-7291
Mailing Address - Fax:775-888-3230
Practice Address - Street 1:2874 N CARSON STREET
Practice Address - Street 2:SUITE 200
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89706-1682
Practice Address - Country:US
Practice Address - Phone:775-883-9003
Practice Address - Fax:775-883-0959
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPN001239363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVAPN001239OtherAPN LICENSE