Jessica Marie Bastian

Primary specialty

Developmental Disabilities Clinic/CenterTaxonomy code 261QD1600X

Practice address

1704 W Main St
Leesburg, FL 34748-4861

Phone

(352) 702-1478

NPI assigned

Apr 6, 2020

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586131200000",
    "number": "1518596030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 43",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327780043",
            "telephone_number": "352-702-1478"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1704 W MAIN ST",
            "city": "LEESBURG",
            "state": "FL",
            "postal_code": "347484861",
            "telephone_number": "352-702-1478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASTIAN",
        "first_name": "JESSICA",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-06",
        "last_updated": "2020-04-06",
        "certification_date": "2020-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261QD1600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sonia Barrett-Bryant, LPN
• Alannah Sherrianne Barrett, MS
• Tiffany Barrett
• Tia Tenease Barriner, APRN, FNP-BC
• Sherrie Bast
• Katrina Denise Battle
• Jennifer Dawn Baxley
• Jessica Lee Beach, LCSW
• Beacon Vision Center, Inc (Beacon Advanced Eyecare)
• Mary Kate Beals, LCSW

• Developmental Disabilities Clinic/Center in Leesburg, FL
• Providers in Leesburg, FL by specialty
• Developmental Disabilities Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.