Provider Demographics
NPI:1386179414
Name:BAUTISTA, MARIAN RAMIREZ (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:RAMIREZ
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIAN
Other - Middle Name:BAUTISTA
Other - Last Name:JAVONILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8695 S 165TH AVE
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1448
Mailing Address - Country:US
Mailing Address - Phone:561-309-4434
Mailing Address - Fax:
Practice Address - Street 1:5401 W THUNDERBIRD RD # 101
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4751
Practice Address - Country:US
Practice Address - Phone:602-530-6189
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174451363LF0000X
AZ283624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily