Provider Demographics
NPI:1851995682
Name:BAZAN, CHRISTINA (FNP-C)
Entity type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BAZAN
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 1:5077 E INTERSTATE 20 SERVICE RD N
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-3219
Mailing Address - Country:US
Mailing Address - Phone:817-374-4949
Mailing Address - Fax:866-493-3919
Practice Address - Street 1:5077 E INTERSTATE 20 SERVICE RD N
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-3219
Practice Address - Country:US
Practice Address - Phone:817-374-4949
Practice Address - Fax:866-493-3919
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018921363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily