Bright Star Pediatric and Adolecent Center
Organization Active NPI Pediatric Nurse Practitioner · Freeport, FL
NPI 1629445846 · NPPES record last updated Aug 24, 2015
Key facts
- NPI
- 1629445846
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pediatric Nurse Practitioner 363LP0200X
- License
- 2080412 (FL)
- Legal business name
- BRIGHT STAR PEDIATRIC AND ADOLECENT CENTER
- Practice address
- 75 Bay Grove Blvd
Freeport, FL 32439-1725 - Phone
- (850) 374-2311
- NPI assigned
- Aug 24, 2015
- Organization subpart
- No
Authorized official
- Name
- Ms. Linda Idean Rich, ARNP
- Title
- Nurse Practitioner
- Phone
- (850) 374-2311
National Provider Directory
Interoperability endpoints
- https://api.platform.athenahealth.com/18069/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Nurse Practitioner |
363LP0200X | 2080412 | FL | Yes |
Addresses
Primary practice location
75 Bay Grove Blvd
Freeport, FL 32439-1725
Mailing address
PO Box 1132
Freeport, FL 32439-1132
Phone (850) 374-2311
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 003-331-800 | Medicaid | FL |
Other providers in Freeport, FL
- Bay Behavioral Group, Inc.
- Bay Behavioral Group, Inc.
- Heather Boswell
- Patricia Bouchet
- Jeanne Elizabeth Brehm
- Shannon Brunson
- Hannah Burch
- Canopy Behavior Solutions, LLC
- Mary Ellen Caswell
- Madelyn Caudill
All providers in Freeport, FL · Pediatric Nurse Practitioner in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 24, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.