Provider Demographics
NPI:1023776309
Name:BAUTISTA, JAYSON LINTAG (APRN)
Entity type:Individual
Prefix:
First Name:JAYSON
Middle Name:LINTAG
Last Name:BAUTISTA
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 SERPENS AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89183-5030
Mailing Address - Country:US
Mailing Address - Phone:714-330-5486
Mailing Address - Fax:
Practice Address - Street 1:2831 SAINT ROSE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4841
Practice Address - Country:US
Practice Address - Phone:702-600-3721
Practice Address - Fax:725-266-7366
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV847774363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily