Healthcare Provider Details

I. General information

NPI: 1841723780
Provider Name (Legal Business Name): CAITLIN LIZBETH BASS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 HEALTH PARK BLVD STE 215
SAINT AUGUSTINE FL
32086-5797
US

IV. Provider business mailing address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

V. Phone/Fax

Practice location:
  • Phone: 904-824-3777
  • Fax: 904-824-6050
Mailing address:
  • Phone: 941-917-7799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME144392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: