Provider Demographics
NPI:1881839124
Name:MICHELLE HINES BAUTISTA ARNP INC
Entity Type:Organization
Organization Name:MICHELLE HINES BAUTISTA ARNP INC
Other - Org Name:THE HORMONE AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:850-215-4455
Mailing Address - Street 1:4237 DAIRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-3099
Mailing Address - Country:US
Mailing Address - Phone:850-215-4445
Mailing Address - Fax:850-215-4492
Practice Address - Street 1:2507 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4424
Practice Address - Country:US
Practice Address - Phone:850-215-4455
Practice Address - Fax:850-215-4492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-15
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care