Healthcare Provider Details

I. General information

NPI: 1497221402
Provider Name (Legal Business Name): NATALIE BASSO LLAMA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE LAUREN BASSO

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

IV. Provider business mailing address

3100 SW 62ND AVE
MIAMI FL
33155-3009
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-6511
  • Fax:
Mailing address:
  • Phone: 305-666-6511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9309616
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: