MS. MALLORY BASTIAN (NPI# 1134779812) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134779812 |
| Entity Type | Individual |
| Full Name | MS. MALLORY BASTIAN |
| Credential | PA |
| Practice Address |
1600 Lakeland Hills Blvd Lakeland FL 33805-3065 |
| Practice Telephone | 8636807214 |
| Practice Fax Number | 8662648519 |
| Mailing Telephone | 8636807000 |
| Mailing Fax Number | 8662648519 |
| Enumeration Date | 2019-09-16 |
| Last Update Date | 2020-09-22 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
9112457 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1600 LAKELAND HILLS BLVD |
| City | LAKELAND |
| State | FL |
| Zip Code | 33805-3065 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316940695 | Watson Clinic LLP | Internal Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2005-05-31 |
| 1134720261 | Hope Dukes | Family Medicine | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3065 | 2020-11-04 |
| 1659994259 | Jessica Lynn Garber | Physician Assistant | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2020-05-19 |
| 1427681410 | Paula Suryani Wibowo | Nurse Practitioner | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2020-02-18 |
| 1932739828 | Ashley Duncan | Nurse Anesthetist, Certified Registered | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3065 | 2020-01-21 |
| 1285273672 | Nicholas Skulimoski | Nurse Anesthetist, Certified Registered | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3065 | 2020-01-02 |
| 1730741356 | Kellie L. Smaidi | Nurse Anesthetist, Certified Registered | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3065 | 2019-07-03 |
| 1982265864 | Alexandra Starzhevskiy | Nurse Practitioner | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2019-06-22 |
| 1548829666 | Ashley Nicole Craig | Nurse Practitioner | 1600 Lakeland Hills Blvd, Lakeland, FL 33805 | 2019-06-12 |
| 1033777941 | Jeremiah James Pastor | Registered Nurse | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3065 | 2019-06-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477188704 | Ernie Tairon Lugo | Nursing Home Administrator | 5210 State Road N 33, Lot 8, Lakeland, FL 33805 | 2020-03-06 |
| 1912546631 | Francis Esperanzate | Physical Therapist | 5070 Menlo Parke Way, Lakeland, FL 33805 | 2019-12-27 |
| 1689232514 | Anointed Touch | Home Health | 617 S Robson Street, Lakeland, FL 33805 | 2019-06-05 |
| 1083160642 | Cherlande Pierre | Chiropractor | 1507 Lakeland Hills Blvd Ste 109, Lakeland, FL 33805 | 2016-09-01 |
| 1992251706 | Damaris Salmeron | Physical Therapy Assistant | 3127 Us Hwy 98 N, Lakeland, FL 33805 | 2016-08-31 |
| 1831589076 | Sarah Mcneill | Pharmacist | 3124 Lakeland Hills Blvd, Lakeland, FL 33805 | 2015-01-26 |
| 1750706479 | Alison M Busby | Counselor | Achievement Academy Inc, 716 E. Bella Vista St, Lakeland, FL 33805 | 2014-03-04 |
| 1174872907 | William Vargas, M.d. P. A. | Anesthesiology | 202 Parkview Place, Lakeland, FL 33805 | 2012-09-07 |
| 1184998056 | Eduardo Francisco Lopez Garcia | Internal Medicine | 135 E First Street, Lakeland, FL 33805 | 2012-02-24 |
| 1255625513 | Navdeep Singh Jassal | Physical Medicine & Rehabilitation | 1417 Lakeland Hills Blvd Ste 201, Lakeland, FL 33805 | 2011-06-04 |
| Find all providers in zip 33805 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760758643 | Sunshine Assistant LLC | Physician Assistant | 6308 Prominence Point Drive, Lakeland, FL 33813-4491 | 2012-03-26 |
| 1992354948 | Joseph Carmine Randazzo Jr. | Physician Assistant | 1324 Lakeland Hills Blvd, Attn: Managed Care Depot, Lakeland, FL 33805-4543 | 2019-09-11 |
| 1659740835 | Laura Zambetti | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2015-09-17 |
| 1528480480 | Jessica Lyons | Physician Assistant | 1600 Lakeland Hills Blvd, Lakeland, FL 33805-3019 | 2014-01-13 |
| 1447502828 | Weslyn A Leffler | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2012-10-09 |
| 1689940934 | Kyle Merritt | Physician Assistant | 1818 Harden Blvd, Suite 120, Lakeland, FL 33803-1812 | 2012-03-30 |
| 1689945693 | Seth D Gardner | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2012-01-23 |
| 1528357183 | Megan E Fincham | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2011-04-05 |
| 1750538294 | Janet Faith Mccabe | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2008-08-27 |
| 1962667881 | William Travis Fann | Physician Assistant | 3030 Harden Blvd, Lakeland, FL 33803-7952 | 2008-07-21 |
| Find all providers in LAKELAND | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.