Provider Demographics
NPI:1831725530
Name:BASCO, CLAIRE SOLOMON (APRN)
Entity type:Individual
Prefix:MRS
First Name:CLAIRE
Middle Name:SOLOMON
Last Name:BASCO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2178 CAVALRY BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-1407
Mailing Address - Country:US
Mailing Address - Phone:904-294-5097
Mailing Address - Fax:
Practice Address - Street 1:1631 RACE TRACK RD STE 101
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3233
Practice Address - Country:US
Practice Address - Phone:904-230-7977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-14
Last Update Date:2020-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11006084363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics