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 1:409 BAYSHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2707
Mailing Address - Country:US
Mailing Address - Phone:813-844-8585
Mailing Address - Fax:813-660-6178
Practice Address - Street 1:409 BAYSHORE BLVD STE 110
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2707
Practice Address - Country:US
Practice Address - Phone:813-844-8585
Practice Address - Fax:813-660-6178
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2734882363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP2734882OtherSTATE LIC.
FL3087034 00Medicaid
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER
FLARNP2734882OtherSTATE LIC.
FL3087034 00Medicaid