Provider Demographics
NPI:1578326989
Name:BRIGHT, NICOLINA CARLA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:NICOLINA
Middle Name:CARLA
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLINA
Other - Middle Name:CARLA
Other - Last Name:INGARGIOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7231 55TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-1346
Mailing Address - Country:US
Mailing Address - Phone:727-269-3049
Mailing Address - Fax:
Practice Address - Street 1:1130 KYLE WOOD LN
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4850
Practice Address - Country:US
Practice Address - Phone:813-600-5423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-31
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9118412363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant