Individual
MISS LATISHA OLIVIA BRISTOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
60 PROSPERITY LN, STAFFORD, VA 22556-4605
(540) 658-2811
Mailing address
5000 COX RD, GLEN ALLEN, VA 23060-9263
(804) 968-5700
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004651
VA
363A00000X
Physician Assistant
PA030279
DC
Other
Enumeration date
12/26/2006
Last updated
02/15/2021
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