Provider Demographics
NPI:1326072398
Name:BAUTISTA, MICHELLE LAVETTE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LAVETTE
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32402-0639
Mailing Address - Country:US
Mailing Address - Phone:850-215-4455
Mailing Address - Fax:850-215-4492
Practice Address - Street 1:508 AIRPORT RD STE G
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4025
Practice Address - Country:US
Practice Address - Phone:850-215-4455
Practice Address - Fax:850-215-4492
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137457363LF0000X
FLARNP 2209302363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily