Provider Demographics
NPI:1427517788
Name:BAUTISTA, GABRIELA ISABEL (MSN, APRN)
Entity type:Individual
Prefix:MRS
First Name:GABRIELA
Middle Name:ISABEL
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:MSN, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2524 OAKLAND SPRING DR
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30039-7961
Mailing Address - Country:US
Mailing Address - Phone:678-760-2474
Mailing Address - Fax:
Practice Address - Street 1:4961 BUFORD HWY
Practice Address - Street 2:
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3535
Practice Address - Country:US
Practice Address - Phone:470-509-4648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN264941163W00000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse