Provider Demographics
NPI:1386160430
Name:NACHLAS, BASYA RACHEL (NP)
Entity type:Individual
Prefix:
First Name:BASYA
Middle Name:RACHEL
Last Name:NACHLAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7690 LAGO DEL MAR DR APT 405
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-4901
Mailing Address - Country:US
Mailing Address - Phone:248-739-1034
Mailing Address - Fax:
Practice Address - Street 1:4675 LINTON BLVD
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-6615
Practice Address - Country:US
Practice Address - Phone:561-049-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9328069363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily