Provider Demographics
NPI:1578887477
Name:BASI, JOSEPH ROCCO (ARNP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROCCO
Last Name:BASI
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28945 STATE ROAD 54 SUITE 102
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-6508
Mailing Address - Country:US
Mailing Address - Phone:813-973-4563
Mailing Address - Fax:813-973-4532
Practice Address - Street 1:28945 STATE ROAD 54 SUITE 102
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-3218
Practice Address - Country:US
Practice Address - Phone:813-973-4563
Practice Address - Fax:813-973-4532
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3154412363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002061000Medicaid
FLY03WBOtherBCBS ATTACHED TO GROUP 40793
FLY03WBOtherBCBS ATTACHED TO GROUP 40793