Provider Demographics
NPI:1114534435
Name:BRIGHTMAN, JANA D (LVN, RN)
Entity Type:Individual
Prefix:
First Name:JANA
Middle Name:D
Last Name:BRIGHTMAN
Suffix:
Gender:F
Credentials:LVN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 154
Mailing Address - Street 2:
Mailing Address - City:FRUITVALE
Mailing Address - State:TX
Mailing Address - Zip Code:75127-0154
Mailing Address - Country:US
Mailing Address - Phone:903-292-8277
Mailing Address - Fax:
Practice Address - Street 1:672 VZ COUNTY ROAD 1922
Practice Address - Street 2:
Practice Address - City:FRUITVALE
Practice Address - State:TX
Practice Address - Zip Code:75127-7512
Practice Address - Country:US
Practice Address - Phone:903-292-8277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-30
Last Update Date:2020-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001338163W00000X
TX339242164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1001338OtherTEXAS BOARD OF NURSING
TX339242OtherTEXAS BOARD OF NURSING