Provider Demographics
NPI:1528452208
Name:BAUTISTA, TAYLOR (PA-C)
Entity type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 BROOKLEY AVE SW BLDG 1300
Mailing Address - Street 2:
Mailing Address - City:BOLLING AFB
Mailing Address - State:DC
Mailing Address - Zip Code:20032-7704
Mailing Address - Country:US
Mailing Address - Phone:202-404-2544
Mailing Address - Fax:
Practice Address - Street 1:238 BROOKLEY AVE SW BLDG 1300
Practice Address - Street 2:
Practice Address - City:BOLLING AFB
Practice Address - State:DC
Practice Address - Zip Code:20032-7704
Practice Address - Country:US
Practice Address - Phone:202-404-2544
Practice Address - Fax:202-404-3197
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-20
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No171000000XOther Service ProvidersMilitary Health Care Provider
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical