Provider Demographics
NPI:1912190125
Name:BRIGHTSTART PEDIATRICS,LLC
Entity Type:Organization
Organization Name:BRIGHTSTART PEDIATRICS,LLC
Other - Org Name:BRIGHTSTART PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, OTR/L
Authorized Official - Phone:407-321-9570
Mailing Address - Street 1:12377 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6215
Mailing Address - Country:US
Mailing Address - Phone:407-857-1212
Mailing Address - Fax:407-857-1239
Practice Address - Street 1:1133 W AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32773-4972
Practice Address - Country:US
Practice Address - Phone:407-321-9570
Practice Address - Fax:407-321-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL60080984261QM3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM3000XAmbulatory Health Care FacilitiesClinic/CenterMedically Fragile Infants and Children Day Care