Healthcare Provider Details

I. General information

NPI: 1326283458
Provider Name (Legal Business Name): PATRICIA MARIE BASTOW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 06/21/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10255 BLOSSOM LAKE DR
SEMINOLE FL
33772-7446
US

IV. Provider business mailing address

10255 BLOSSOM LAKE DR
SEMINOLE FL
33772-7446
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-2769
  • Fax:
Mailing address:
  • Phone: 727-398-2769
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9228853
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: