MEDICARE: BRIGHT MEDCARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner
2	363AM0700X	Medical Physician Assistant

General Provider Information

NPI Number	:	1730424763
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRIGHT MEDCARE LLC

Provider Business Mailing Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-963-1899
Fax Number	:	954-963-5613

Provider Business Practice Location Address
First Line	:	2544 N STATE ROAD 7
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-3205
Country	:	US
Telephone Number	:	954-963-1899
Fax Number	:	954-963-5613

Authorized Official
Title or Position	:	MBR
Name	:	MARK CERECEDA
Credential	:	D.C,
Telephone Number	:	954-963-1899

Provider Enumeration Date	:	12/03/2012
Last Update Date	:	12/03/2012

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Directions to “BRIGHT MEDCARE LLC ” Practice Location

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