Provider Demographics
NPI:1043611817
Name:BASTIANO, PAMELA (DNP-PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:BASTIANO
Suffix:
Gender:F
Credentials:DNP-PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10770 N 46TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-3442
Mailing Address - Country:US
Mailing Address - Phone:813-631-2516
Mailing Address - Fax:
Practice Address - Street 1:10770 N 46TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-3442
Practice Address - Country:US
Practice Address - Phone:813-631-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9297409101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)