Provider Demographics
NPI:1215380969
Name:AMISTAD, WILLIAM BAUTISTA JR (FNP)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BAUTISTA
Last Name:AMISTAD
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:100 E 24TH ST STE 3A
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8619
Mailing Address - Country:US
Mailing Address - Phone:928-750-6410
Mailing Address - Fax:928-750-6433
Practice Address - Street 1:100 E 24TH ST STE 3A
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8619
Practice Address - Country:US
Practice Address - Phone:928-750-6410
Practice Address - Fax:928-750-6433
Is Sole Proprietor?:No
Enumeration Date:2016-07-18
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZAP9557363LF0000X
AZRN171460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily