Provider Demographics
NPI:1013102409
Name:BASTIEN, NATALIE EUDORA (ARNP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:EUDORA
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2044 TRINITY OAKS BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4406
Mailing Address - Country:US
Mailing Address - Phone:727-645-6900
Mailing Address - Fax:727-372-8989
Practice Address - Street 1:2044 TRINITY OAKS BLVD STE 220
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4406
Practice Address - Country:US
Practice Address - Phone:727-645-6900
Practice Address - Fax:727-372-8989
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN2734882363L00000X
FLARNP2734882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2734882OtherSTATE LIC.
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FL3087034 00Medicaid
FLARNP2734882OtherSTATE LIC.
FL3087034 00Medicaid