Provider Demographics
NPI:1679337646
Name:BHAVSAR, PAYAL SAMIR (FNP-BC)
Entity Type:Individual
Prefix:MISS
First Name:PAYAL
Middle Name:SAMIR
Last Name:BHAVSAR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9913 LIGHTNER WAY
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3042
Mailing Address - Country:US
Mailing Address - Phone:661-593-9193
Mailing Address - Fax:
Practice Address - Street 1:17450 MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6262
Practice Address - Country:US
Practice Address - Phone:949-783-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95192484163WC0200X
CA95027970363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine