Provider Demographics
NPI:1417612664
Name:GERGES, BASSANT (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BASSANT
Middle Name:
Last Name:GERGES
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15026 ARBOR HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3142
Mailing Address - Country:US
Mailing Address - Phone:201-423-6023
Mailing Address - Fax:
Practice Address - Street 1:15026 ARBOR HOLLOW DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3142
Practice Address - Country:US
Practice Address - Phone:201-423-6023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016267363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily