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General NPI Number Information
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NPI Number | 1053215566
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Entity Type | Individual
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Provider Name | JESSICA BRUCETA PMHNP
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Gender | Female
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Dates
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Enumeration Date | 10/07/2026
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Last Update Date | 10/07/2026
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Provider Practice Location Address
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Address Line | 2900 W CYPRESS CREEK RD STE 13
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City | FT LAUDERDALE
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State | FL
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Zip | 33309-1715
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Country | US
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Telephone | 786-660-0778
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Fax |
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Provider Business Mailing Address
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Address Line | 2217 NW 40TH AVE
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City | COCONUT CREEK
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State | FL
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Zip | 33066-2033
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 11051258
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License Number State | FL
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