Provider Demographics
NPI:1275894396
Name:BASTIEN, SEM INOE (ARNP)
Entity Type:Individual
Prefix:
First Name:SEM
Middle Name:INOE
Last Name:BASTIEN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10051 5TH ST N
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-2289
Mailing Address - Country:US
Mailing Address - Phone:813-885-5817
Mailing Address - Fax:813-886-9421
Practice Address - Street 1:5537 SHELDON RD
Practice Address - Street 2:SUITE K
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-3153
Practice Address - Country:US
Practice Address - Phone:813-885-5817
Practice Address - Fax:813-886-9421
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2016-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL9188810363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006479300Medicaid
FLGE810XMedicare PIN