Provider Demographics
NPI:1164684015
Name:BASTIS, JENNIFER ESLER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ESLER
Last Name:BASTIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:382 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-7324
Mailing Address - Country:US
Mailing Address - Phone:781-848-1555
Mailing Address - Fax:781-848-2313
Practice Address - Street 1:99 LONGWATER CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:NORWELL
Practice Address - State:MA
Practice Address - Zip Code:02061-1642
Practice Address - Country:US
Practice Address - Phone:781-659-1800
Practice Address - Fax:781-659-7221
Is Sole Proprietor?:No
Enumeration Date:2008-07-01
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical