Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN11011213 | FL |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | APRN11011213 | FL |
N | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | APRN11011213 | FL |
NPI | 1629621917 |
---|---|
Provider Name | Rene Bascoy |
First Address | Miami, FL 33186-4750 |
Second Address | Hollywood, FL 33021-5421 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2019 |
Last Update Date | 26/05/2021 |