Provider Demographics
NPI:1699150953
Name:BASTIEN, BRUNETTE (ARNP)
Entity type:Individual
Prefix:
First Name:BRUNETTE
Middle Name:
Last Name:BASTIEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 VISCAYA PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3294
Mailing Address - Country:US
Mailing Address - Phone:239-293-5829
Mailing Address - Fax:239-236-1200
Practice Address - Street 1:1425 VISCAYA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3294
Practice Address - Country:US
Practice Address - Phone:239-919-4851
Practice Address - Fax:239-236-1200
Is Sole Proprietor?:No
Enumeration Date:2015-07-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2971515163WP0808X
FL9271515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily