IndividualActive
Tina Bristol
NPI 1346994845 · Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility · Jacksonville, FL
Provider details
- NPI number
- 1346994845
- Entity type
- Individual
- Primary specialty
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityResidential Treatment Facilities
- Sex
- Female
- Sole proprietor
- Yes
- License
- 016780800 (FL)
Specialties & taxonomies
- Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityPrimary320900000XLicense 016780800 (FL)
Residential Treatment Facilities
Profile Score
Established profile(61/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
4 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
4455 Ish Brant Rd W
Jacksonville, FL 32210-7046
Phone: (904) 377-6612
Street-level locationGet directions
Mailing address
4455 Ish Brant Rd W
Jacksonville, FL 32210-7046
Registry dates
- Enumerated
- 2022-02-04
- Last updated
- 2022-02-04
- Certified
- 2022-02-04
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.