Provider Demographics
NPI:1215579198
Name:BASTIEN, VANISE (APRN, DNP STUDENT)
Entity type:Individual
Prefix:
First Name:VANISE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:APRN, DNP STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9870 WATERMILL CIRCLE
Mailing Address - Street 2:E
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437
Mailing Address - Country:US
Mailing Address - Phone:321-368-4868
Mailing Address - Fax:
Practice Address - Street 1:9870 WATERMILL CIRCLE
Practice Address - Street 2:E
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-608-0088
Practice Address - Fax:866-728-9456
Is Sole Proprietor?:No
Enumeration Date:2019-10-12
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023512363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health