Provider Demographics
NPI:1790102796
Name:RADWAN, BASSAM KASSEM (ARNP)
Entity Type:Individual
Prefix:MR
First Name:BASSAM
Middle Name:KASSEM
Last Name:RADWAN
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5340 GULF DR STE 105
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3922
Mailing Address - Country:US
Mailing Address - Phone:727-849-0222
Mailing Address - Fax:727-847-7685
Practice Address - Street 1:5340 GULF DR STE 105
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3922
Practice Address - Country:US
Practice Address - Phone:727-849-0222
Practice Address - Fax:727-847-7685
Is Sole Proprietor?:No
Enumeration Date:2014-03-27
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9229372363LF0000X
FLARNP9229372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily