Provider Demographics
NPI:1891558649
Name:BRIGHTWAY PSYCHIATRY
Entity Type:Organization
Organization Name:BRIGHTWAY PSYCHIATRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:VANISE
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:321-368-4868
Mailing Address - Street 1:9870 WATERMILL CIR APT E
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-2815
Mailing Address - Country:US
Mailing Address - Phone:321-368-4868
Mailing Address - Fax:
Practice Address - Street 1:9870 WATERMILL CIR APT E
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-2815
Practice Address - Country:US
Practice Address - Phone:561-608-0088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health