Healthcare Provider Details

I. General information

NPI: 1518553015
Provider Name (Legal Business Name): IANTHA BAZILE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2020
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

306 LINCOLN RD
MIAMI BEACH FL
33139-3103
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-5274
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9524544
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberCNM10900
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: