Provider Demographics
NPI:1386179414
Name:BAUTISTA, MARIAN RAMIREZ (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:RAMIREZ
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:BAUTISTA
Other - Last Name:JAVONILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1719 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85392-1213
Mailing Address - Country:US
Mailing Address - Phone:623-232-3322
Mailing Address - Fax:844-307-7669
Practice Address - Street 1:1719 N DYSART RD
Practice Address - Street 2:
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85392-1213
Practice Address - Country:US
Practice Address - Phone:623-232-3322
Practice Address - Fax:844-307-7669
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-26
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174451363LF0000X
AZ283624363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily