Provider Demographics
NPI:1083233571
Name:BASULTO, JANISSET (FNP, APRN)
Entity Type:Individual
Prefix:
First Name:JANISSET
Middle Name:
Last Name:BASULTO
Suffix:
Gender:F
Credentials:FNP, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20051 NW 77TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6419
Mailing Address - Country:US
Mailing Address - Phone:786-797-7134
Mailing Address - Fax:
Practice Address - Street 1:20051 NW 77TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6419
Practice Address - Country:US
Practice Address - Phone:786-797-7134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006727363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily