Basic Information
| Provider Information | |||||||||
| NPI: | 1013102409 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASTIEN | ||||||||
| FirstName: | NATALIE | ||||||||
| MiddleName: | EUDORA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 507 W ALEXANDER ST | ||||||||
| Address2: | |||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335637136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278207778 | ||||||||
| FaxNumber: | 7278207779 | ||||||||
| Practice Location | |||||||||
| Address1: | 2191 9TH AVE N | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337137146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278207778 | ||||||||
| FaxNumber: | 7278207779 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2007 | ||||||||
| LastUpdateDate: | 07/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP2734882 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
ID Information
| ID | Type | State | Issuer | Description | DA5786 | 01 | FL | RAILROAD MEDICARE GROUP NUMBER | OTHER | ARNP2734882 | 01 | FL | STATE LIC. | OTHER | 3087034 00 | 05 | FL | MEDICAID |