MEDICARE: MR. WILLIAM BAUTISTA AMISTAD JR. FNP

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	363LF0000X	Family Nurse Practitioner	RN171460	AZ
2	363LF0000X	Family Nurse Practitioner	AP9557	AZ

General Provider Information

NPI Number	:	1215380969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM BAUTISTA AMISTAD JR. FNP

Provider Business Mailing Address
First Line	:	100 E 24TH ST STE 3A
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8619
Country	:	US
Telephone Number	:	928-750-6410
Fax Number	:	928-750-6433

Provider Business Practice Location Address
First Line	:	100 E 24TH ST STE 3A
Second Line	:
City	:	YUMA
State	:	AZ
Zip	:	85364-8619
Country	:	US
Telephone Number	:	928-750-6410
Fax Number	:	928-750-6433

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2016
Last Update Date	:	02/24/2025

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