Healthcare Provider Details

I. General information

NPI: 1730424763
Provider Name (Legal Business Name): BRIGHT MEDCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2012
Last Update Date: 12/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2544 N STATE ROAD 7
HOLLYWOOD FL
33021-3205
US

IV. Provider business mailing address

2544 N STATE ROAD 7
HOLLYWOOD FL
33021-3205
US

V. Phone/Fax

Practice location:
  • Phone: 954-963-1899
  • Fax: 954-963-5613
Mailing address:
  • Phone: 954-963-1899
  • Fax: 954-963-5613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARK CERECEDA
Title or Position: MBR
Credential: D.C,
Phone: 954-963-1899