Provider Demographics
NPI:1841723780
Name:BASS, CAITLIN LIZBETH (MD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:LIZBETH
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3509
Mailing Address - Country:US
Mailing Address - Phone:941-917-7799
Mailing Address - Fax:
Practice Address - Street 1:201 HEALTH PARK BLVD STE 215
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5797
Practice Address - Country:US
Practice Address - Phone:904-824-3777
Practice Address - Fax:904-824-6050
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME144392207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program