Provider Demographics
NPI:1578722856
Name:BRIGHT, NICOLE JASMYN (DO)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:JASMYN
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BECKETT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOGAN TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1547
Mailing Address - Country:US
Mailing Address - Phone:856-241-3311
Mailing Address - Fax:856-241-3969
Practice Address - Street 1:545 BECKETT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOGAN TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08085-1547
Practice Address - Country:US
Practice Address - Phone:856-241-3311
Practice Address - Fax:856-241-3969
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT011840207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology