Individual
TINA ROSE BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
4500 W MIDWAY RD, FORT PIERCE, FL 34981-4823
(772) 672-8481
Mailing address
472 SW BAOY AVE, PORT ST LUCIE, FL 34953-3813
(772) 216-0770
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
9301212
FL
Other
Enumeration date
12/09/2011
Last updated
12/09/2011
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