Healthcare Provider Details

I. General information

NPI: 1487611174
Provider Name (Legal Business Name): KAREN MARIE BASILE A.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 1ST ST
NEPTUNE BEACH FL
32266-6145
US

IV. Provider business mailing address

575 VIKINGS LN
ATLANTIC BEACH FL
32233-4150
US

V. Phone/Fax

Practice location:
  • Phone: 904-249-2118
  • Fax:
Mailing address:
  • Phone: 904-249-2118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number2105
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: