Provider Demographics
NPI:1285663492
Name:BAUTISTA, SILVIA B (FNP)
Entity Type:Individual
Prefix:
First Name:SILVIA
Middle Name:B
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:SYLVIA
Other - Middle Name:
Other - Last Name:PEDROZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:122 W JOHN CARPENTER FWY STE 420
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-2014
Mailing Address - Country:US
Mailing Address - Phone:972-957-3000
Mailing Address - Fax:
Practice Address - Street 1:701 S STEMMONS FWY STE 260
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4591
Practice Address - Country:US
Practice Address - Phone:972-316-6495
Practice Address - Fax:972-316-6500
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2020-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP106905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181611801Medicaid
TX8Y0237OtherBCBS
TXP00330098OtherRR MCARE
TX8G7122Medicare PIN
TXP23706Medicare UPIN