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General NPI Number Information
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NPI Number | 1114669991
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Entity Type | Organization
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Legal Business Name | BRIGHTSOUL BEHAVIORAL & MEDICAL HEALTHCARE
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 6100 LAKE ELLENOR DR STE 205
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City | ORLANDO
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State | FL
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Zip | 32809-4632
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Country | US
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Telephone | 407-412-6652
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Fax | 407-412-6668
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Provider Business Mailing Address
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Address Line | 2098 WINNETKA CT
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City | ORLANDO
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State | FL
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Zip | 32818-5325
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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 | APRN
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Name | ESTHER LUC PELISSIER
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Credential | PMHNP
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Telephone | 407-412-6652
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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 |
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License Number State |
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