Healthcare Provider Details

I. General information

NPI: 1265387252
Provider Name (Legal Business Name): TANIA EFIGENIA BASTARDO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2026
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12662 TELECOM DR
TEMPLE TERRACE FL
33637-0935
US

IV. Provider business mailing address

12662 TELECOM DR
TEMPLE TERRACE FL
33637-0935
US

V. Phone/Fax

Practice location:
  • Phone: 813-813-2787
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF11250203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: