Jacqueline K Bruder, PMD

Primary specialty

ParamedicTaxonomy code 146L00000X

License

JA7201 Issued in FL

Practice address

1625 N Commerce Pkwy Ste 300
Weston, FL 33326-3206

Phone

(954) 765-6262

NPI assigned

Jan 17, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mended Minds Corp.

  • Clinic/Center
  • Weston, FL
  • NPI 1225675226

  Technician, Other

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589241600000",
    "number": "1700416807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2640 SW 137TH TER",
            "city": "DAVIE",
            "state": "FL",
            "postal_code": "333301132",
            "telephone_number": "954-214-4426"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 N COMMERCE PKWY STE 300",
            "city": "WESTON",
            "state": "FL",
            "postal_code": "333263206",
            "telephone_number": "954-765-6262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUDER",
        "first_name": "JACQUELINE",
        "middle_name": "K",
        "credential": "PMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-05-12",
        "certification_date": "2020-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "FL",
            "license": "JA7201",
            "primary": false
        },
        {
            "code": "146L00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Paramedic",
            "state": "FL",
            "license": "JA7201",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dianne Brown IV, COTA
• Gabriela Brown
• Stephanie Maria Brown, CRNA
• Yasheka Brown
• Hugh Bruder, PMD
• Katherine Elizabeth Bucci, MD
• Paul Robert Buchanan, PA-C
• Buddha's Den Wellness Center LLC
• Maria del Rocio Buechler, LCSW
• Baokhoi Bui, DDS

• Paramedic in Weston, FL
• Providers in Weston, FL by specialty
• Paramedic in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.