MEDICARE: NATHAN RODNEY BASS APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11047956	FL

General Provider Information

NPI Number	:	1043142151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN RODNEY BASS APRN

Provider Business Mailing Address
First Line	:	1607 NW FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-9600
Country	:	US
Telephone Number	:	772-828-9287
Fax Number	:

Provider Business Practice Location Address
First Line	:	1607 NW FEDERAL HWY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34994-9600
Country	:	US
Telephone Number	:	772-828-9287
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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