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General NPI Number Information
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NPI Number | 1629445846
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Entity Type | Organization
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Legal Business Name | BRIGHT STAR PEDIATRIC AND ADOLECENT CENTER
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 08/24/2015
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Provider Practice Location Address
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Address Line | 75 BAY GROVE BLVD
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City | FREEPORT
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State | FL
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Zip | 32439-1725
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Country | US
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Telephone | 850-374-2311
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1132
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City | FREEPORT
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State | FL
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Zip | 32439-1132
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Country | US
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Telephone | 850-374-2311
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MS. LINDA IDEAN RICH
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Credential | ARNP
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Telephone | 850-374-2311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 2080412
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License Number State | FL
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