Healthcare Provider Details

I. General information

NPI: 1053215566
Provider Name (Legal Business Name): JESSICA BRUCETA PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2026
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W CYPRESS CREEK RD STE 13
FT LAUDERDALE FL
33309-1715
US

IV. Provider business mailing address

2217 NW 40TH AVE
COCONUT CREEK FL
33066-2033
US

V. Phone/Fax

Practice location:
  • Phone: 786-660-0778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11051258
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: