Provider Demographics
NPI:1598259194
Name:BAUTISTA, TIFFANY N (ARNP)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:N
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TIFFANY
Other - Middle Name:N
Other - Last Name:GARZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:550 GAGE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-9532
Mailing Address - Country:US
Mailing Address - Phone:509-942-2648
Mailing Address - Fax:509-942-2812
Practice Address - Street 1:888 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-3514
Practice Address - Country:US
Practice Address - Phone:509-942-2644
Practice Address - Fax:509-942-2753
Is Sole Proprietor?:No
Enumeration Date:2018-06-18
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60865159363LN0005X, 363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care