MEDICARE: IRISH BAUTISTA NP

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	AP140719	TX

General Provider Information

NPI Number	:	1720638463
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRISH BAUTISTA NP

Provider Business Mailing Address
First Line	:	2700 TRAVIS ST APT 4048
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77006-3579
Country	:	US
Telephone Number	:	956-624-5134
Fax Number	:

Provider Business Practice Location Address
First Line	:	9721 BROADWAY ST STE 111
Second Line	:
City	:	PEARLAND
State	:	TX
Zip	:	77584-8170
Country	:	US
Telephone Number	:	713-436-3637
Fax Number	:

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

Provider Enumeration Date	:	09/15/2019
Last Update Date	:	09/15/2019

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Directions to “ IRISH BAUTISTA NP” Practice Location

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