Provider Demographics
NPI:1467112599
Name:BAUTISTA MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:BAUTISTA MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:910-920-6505
Mailing Address - Street 1:5221 BENTGRASS WAY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-1703
Mailing Address - Country:US
Mailing Address - Phone:910-920-6505
Mailing Address - Fax:
Practice Address - Street 1:5221 BENTGRASS WAY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1703
Practice Address - Country:US
Practice Address - Phone:910-920-6505
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-30
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty