Healthcare Provider Details

I. General information

NPI: 1447806047
Provider Name (Legal Business Name): SABRINA NICOLE BAZAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2019
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 ROBESON ST STE 203
FAYETTEVILLE NC
28305-5641
US

IV. Provider business mailing address

345 N SAN PEDRO ST
LAS CRUCES NM
88001-3462
US

V. Phone/Fax

Practice location:
  • Phone: 910-615-3220
  • Fax: 910-486-2170
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57154
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5021777
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: