Provider Demographics
NPI:1326440868
Name:WESLEY CHAPEL NEUROLOGY, P.A.
Entity Type:Organization
Organization Name:WESLEY CHAPEL NEUROLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASI
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:813-973-4563
Mailing Address - Street 1:28945 STATE ROAD 54
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543
Mailing Address - Country:US
Mailing Address - Phone:813-973-4563
Mailing Address - Fax:813-973-4532
Practice Address - Street 1:28945 STATE ROAD 54
Practice Address - Street 2:SUITE 102
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-973-4563
Practice Address - Fax:813-973-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-16
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3154412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHZ756AMedicare PIN