Provider Demographics
NPI:1316663883
Name:BRISTOL, AMANI
Entity type:Individual
Prefix:
First Name:AMANI
Middle Name:
Last Name:BRISTOL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9128 PARK RICHEY BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-8139
Mailing Address - Country:US
Mailing Address - Phone:727-247-6738
Mailing Address - Fax:
Practice Address - Street 1:9128 PARK RICHEY BLVD
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-8139
Practice Address - Country:US
Practice Address - Phone:727-247-6738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services