MISS Latisha Olivia Bristol, PA

NPI #1265597538 in Stafford, Virginia

Provider Information

NPI Number: 1265597538
Entity Type: Individual
Name: MISS Latisha Olivia Bristol, PA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physician Assistant
Credential: PA
Enumeration Date: Dec 26, 2006
Last Updated: Feb 15, 2021

Practice Location

Address: 60 PROSPERITY LN
City: Stafford
State: Virginia
ZIP Code: 22556-4605
Phone: (540) 658-2811

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physician Assistant	363A00000X	Primary

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