Michael Eric Bristow
Nurse Practitioner - Gerontology
11481 Old Saint Augustine Rd Ste 303
Jacksonville
, Florida 32258-1476
Michael Eric Bristow
Nurse Practitioner - Gerontology
11481 Old Saint Augustine Rd Ste 303
Jacksonville
, Florida 32258-1476
(904) 580-4730
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About
Features
Specialties
- Nurse Practitioner - Gerontology
Languages spoken
- English
Location
First Address
- Michael Eric Bristow
- 5150 Belfort Rd Bldg 400
- Jacksonville, FL
- Zip : 32256-6026
- Phone : (904) 580-4730
Second Address
- Michael Eric Bristow
- 11481 Old Saint Augustine Rd Ste 303
- Jacksonville, FL
- Zip : 32258-1476
- Fax : (904) 580-4740
- Phone : (904) 580-4730
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 363LG0600X | Nurse Practitioner - Gerontology | 3200922 | FL |
National Provider Identifier
| NPI | 1003312539 |
|---|---|
| Provider Name | Michael Eric Bristow |
| First Address | Jacksonville, FL 32256-6026 |
| Second Address | Jacksonville, FL 32258-1476 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/04/2018 |
| Last Update Date | 02/06/2020 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.