MEDICARE: BAUTISTA MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1467112599
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAUTISTA MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	5221 BENTGRASS WAY
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-1703
Country	:	US
Telephone Number	:	910-920-6505
Fax Number	:

Provider Business Practice Location Address
First Line	:	5221 BENTGRASS WAY
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34211-1703
Country	:	US
Telephone Number	:	910-920-6505
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. NATASHA SHARPE
Credential	:	ARNP
Telephone Number	:	910-920-6505

Provider Enumeration Date	:	12/30/2021
Last Update Date	:	03/11/2024

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