Provider Demographics
NPI:1790057859
Name:BASS, WILLIAM BERNARD (ARNP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BERNARD
Last Name:BASS
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 1:1801 SE HILLMOOR DR STE B-105
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7545
Mailing Address - Country:US
Mailing Address - Phone:772-398-9911
Mailing Address - Fax:772-398-4374
Practice Address - Street 1:1801 SE HILLMOOR DR STE B-105
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7545
Practice Address - Country:US
Practice Address - Phone:772-398-9911
Practice Address - Fax:772-398-4374
Is Sole Proprietor?:No
Enumeration Date:2012-02-06
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9193378207Y00000X, 363L00000X
FL9193378363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health