Provider Demographics
NPI:1922441146
Name:BASS, CHAD ROBERT (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CHAD
Middle Name:ROBERT
Last Name:BASS
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Gender:M
Credentials:CRNA
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Mailing Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:800-394-4445
Mailing Address - Fax:706-650-1034
Practice Address - Street 1:2727 W DR MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:800-394-4445
Practice Address - Fax:706-650-1034
Is Sole Proprietor?:No
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
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Provider Licenses
StateLicense IDTaxonomies
FL9258111367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered