Provider Demographics
NPI:1053738732
Name:BRISTOW, ALICE SPRINGER (CRNP)
Entity type:Individual
Prefix:MS
First Name:ALICE
Middle Name:SPRINGER
Last Name:BRISTOW
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7980 BEAU RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MC CALLA
Mailing Address - State:AL
Mailing Address - Zip Code:35111-4134
Mailing Address - Country:US
Mailing Address - Phone:205-477-5265
Mailing Address - Fax:
Practice Address - Street 1:28921 HIGHWAY 5
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:AL
Practice Address - Zip Code:35188-3613
Practice Address - Country:US
Practice Address - Phone:205-938-9348
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-108892363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily