Provider Demographics
NPI:1942750757
Name:BAYACA, BRILLANTE MARARAC (RN)
Entity Type:Individual
Prefix:MR
First Name:BRILLANTE
Middle Name:MARARAC
Last Name:BAYACA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4603 FONSO DR
Mailing Address - Street 2:
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-6129
Mailing Address - Country:US
Mailing Address - Phone:336-575-8693
Mailing Address - Fax:
Practice Address - Street 1:4603 FONSO DR
Practice Address - Street 2:
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-6129
Practice Address - Country:US
Practice Address - Phone:336-575-8693
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC127063163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical