Healthcare Provider Details

I. General information

NPI: 1790008191
Provider Name (Legal Business Name): MARCIA B BASS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 S JEFFERSON ST
PERRY FL
32348
US

IV. Provider business mailing address

1211 N CENTER ST
PERRY FL
32347-2037
US

V. Phone/Fax

Practice location:
  • Phone: 850-584-2141
  • Fax: 850-838-2140
Mailing address:
  • Phone: 850-584-2141
  • Fax: 850-838-2140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP9176944
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: