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General NPI Number Information
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NPI Number | 1790102796
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Entity Type | Individual
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Provider Name | BASSAM KASSEM RADWAN ARNP
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Gender | Male
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Dates
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Enumeration Date | 03/27/2014
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Last Update Date | 03/08/2016
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Provider Practice Location Address
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Address Line | 5340 GULF DR STE 105
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-3922
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Country | US
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Telephone | 727-849-0222
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Fax | 727-847-7685
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Provider Business Mailing Address
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Address Line | 5340 GULF DR STE 105
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-3922
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Country | US
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Telephone | 727-849-0222
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Fax | 727-847-7685
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 9229372
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9229372
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License Number State | FL
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