Provider Demographics
NPI:1114669991
Name:BRIGHTSOUL BEHAVIORAL & MEDICAL HEALTHCARE
Entity Type:Organization
Organization Name:BRIGHTSOUL BEHAVIORAL & MEDICAL HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:ESTHER LUC
Authorized Official - Middle Name:
Authorized Official - Last Name:PELISSIER
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP
Authorized Official - Phone:407-412-6652
Mailing Address - Street 1:2098 WINNETKA CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32818-5325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6100 LAKE ELLENOR DR STE 205
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-4632
Practice Address - Country:US
Practice Address - Phone:407-412-6652
Practice Address - Fax:407-412-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty