MEDICARE: MRS. CLAIRE SOLOMON BASCO 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	363LP0200X	Pediatric Nurse Practitioner	11006084	FL

General Provider Information

NPI Number	:	1831725530
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CLAIRE SOLOMON BASCO APRN

Provider Business Mailing Address
First Line	:	2178 CAVALRY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32246-1407
Country	:	US
Telephone Number	:	904-294-5097
Fax Number	:

Provider Business Practice Location Address
First Line	:	1631 RACE TRACK RD STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-3233
Country	:	US
Telephone Number	:	904-230-7977
Fax Number	:

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

Provider Enumeration Date	:	03/14/2020
Last Update Date	:	03/14/2020

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