Provider Demographics
NPI:1003514985
Name:GABAT, ANGELIQUE BAUTISTA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:BAUTISTA
Last Name:GABAT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 W. AUGUSTA BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642
Mailing Address - Country:US
Mailing Address - Phone:773-248-2255
Mailing Address - Fax:773-304-4143
Practice Address - Street 1:1203 W. AUGUSTA BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642
Practice Address - Country:US
Practice Address - Phone:773-248-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily