Healthcare Provider Details

I. General information

NPI: 1184404824
Provider Name (Legal Business Name): BRIGHTSTAR LAB PRO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2023
Last Update Date: 10/07/2023
Certification Date: 10/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 ALOMA AVE STE 126
WINTER PARK FL
32792-3752
US

IV. Provider business mailing address

3001 ALOMA AVE STE 126
WINTER PARK FL
32792-3752
US

V. Phone/Fax

Practice location:
  • Phone: 407-672-1609
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State

VIII. Authorized Official

Name: RESHEMA JELKS
Title or Position: CEO
Credential:
Phone: 407-672-1609