MEDICARE: ROBIN ANN BASSETT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	9469591	FL
2	363LF0000X	Family Nurse Practitioner	1152	AK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760703110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN ANN BASSETT APRN

Provider Business Mailing Address
First Line	:	311 N CLYDE MORRIS BLVD STE 360
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2757
Country	:	US
Telephone Number	:	386-425-4650
Fax Number	:	386-425-7510

Provider Business Practice Location Address
First Line	:	311 N CLYDE MORRIS BLVD STE 360
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-2757
Country	:	US
Telephone Number	:	386-425-4650
Fax Number	:	386-425-7510

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	04/27/2021

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