Provider Demographics
NPI:1275110280
Name:BAUTISTA, NEIL NAVALES (FNP)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:NAVALES
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 S EADS ST APT 1408
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4725
Mailing Address - Country:US
Mailing Address - Phone:805-252-9549
Mailing Address - Fax:
Practice Address - Street 1:2901 TELESTAR CT STE 200
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-1262
Practice Address - Country:US
Practice Address - Phone:703-573-3494
Practice Address - Fax:703-573-5353
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001286879163WG0000X
VA0024181168363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care