Individual
MS. CONNIE S BRISTOW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
3151 N ALAFAYA TRL, 101, ORLANDO, FL 32826-2945
(407) 207-5000
Mailing address
2014 TAYLOR AVE, WINTER PARK, FL 32792-3133
(407) 207-5000
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA1630
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
290289300
—
FL
01
—
Y02YJ
BCBS
FL
Enumeration date
08/01/2006
Last updated
02/24/2010
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