Provider Demographics
NPI:1184969651
Name:BAUTISTA, DANIELLE (ANP)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-1848
Mailing Address - Country:US
Mailing Address - Phone:415-495-2225
Mailing Address - Fax:415-495-2228
Practice Address - Street 1:363 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1729
Practice Address - Country:US
Practice Address - Phone:650-306-9490
Practice Address - Fax:650-306-0250
Is Sole Proprietor?:No
Enumeration Date:2012-12-10
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2012013516363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health