Provider Demographics
NPI:1124379573
Name:BAUTISTA, JANICE HUMIDING (APN)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:HUMIDING
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 NEPTUNE BLVD, 2ND FLOOR
Mailing Address - Street 2:
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-4121
Mailing Address - Country:US
Mailing Address - Phone:732-775-5300
Mailing Address - Fax:732-775-1737
Practice Address - Street 1:444 NEPTUNE BLVD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-4121
Practice Address - Country:US
Practice Address - Phone:732-775-5300
Practice Address - Fax:732-775-1737
Is Sole Proprietor?:No
Enumeration Date:2012-09-25
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00330400363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health