Provider Demographics
NPI:1568236321
Name:SORAYA BASTIEN APRN LLC
Entity Type:Organization
Organization Name:SORAYA BASTIEN APRN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SORAYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASTIEN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:786-650-8688
Mailing Address - Street 1:3448 SE 3RD ST
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6060
Mailing Address - Country:US
Mailing Address - Phone:786-650-8688
Mailing Address - Fax:
Practice Address - Street 1:2330 SE 23RD RD
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33035-1900
Practice Address - Country:US
Practice Address - Phone:786-650-8688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-13
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty