MEDICARE: JEAN DOMANTAY BAYABOS FNP-C

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	AP141537	TX

General Provider Information

NPI Number	:	1518522291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEAN DOMANTAY BAYABOS FNP-C

Provider Business Mailing Address
First Line	:	2821 NORTHGATE LN
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-6252
Country	:	US
Telephone Number	:	361-774-1526
Fax Number	:

Provider Business Practice Location Address
First Line	:	1700 W DOVE AVE STE 80
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-4464
Country	:	US
Telephone Number	:	956-467-5920
Fax Number	:

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

Provider Enumeration Date	:	05/07/2019
Last Update Date	:	05/07/2019

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