Healthcare Provider Details

I. General information

NPI: 1043142151
Provider Name (Legal Business Name): NATHAN RODNEY BASS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 NW FEDERAL HWY
STUART FL
34994-9600
US

IV. Provider business mailing address

1607 NW FEDERAL HWY
STUART FL
34994-9600
US

V. Phone/Fax

Practice location:
  • Phone: 772-828-9287
  • Fax:
Mailing address:
  • Phone: 772-828-9287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11047956
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: