Healthcare Provider Details

I. General information

NPI: 1073293775
Provider Name (Legal Business Name): CHRISTOPHER BASCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13715 RICHMOND PARK DR N UNIT 401
JACKSONVILLE FL
32224-5277
US

IV. Provider business mailing address

13715 RICHMOND PARK DR N UNIT 401
JACKSONVILLE FL
32224-5277
US

V. Phone/Fax

Practice location:
  • Phone: 904-593-8514
  • Fax: 904-593-8515
Mailing address:
  • Phone: 904-593-8514
  • Fax: 904-593-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11027433
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberAPRN11027433
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: