Provider Demographics
NPI:1285471730
Name:BAUTISTA, BEATRIZ ELIZABETH (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:ELIZABETH
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 S JEFFERSON ST STE 1006
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24011-1713
Mailing Address - Country:US
Mailing Address - Phone:540-224-5353
Mailing Address - Fax:
Practice Address - Street 1:1151 KEEZLETOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-2337
Practice Address - Country:US
Practice Address - Phone:540-981-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-11
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190719363LF0000X
VA0001267451363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily