Provider Demographics
NPI:1831712157
Name:BAUTISTA, HIJA MAE (DNP, AGNP-C)
Entity type:Individual
Prefix:DR
First Name:HIJA
Middle Name:MAE
Last Name:BAUTISTA
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Gender:F
Credentials:DNP, AGNP-C
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Mailing Address - Street 1:3033 N CENTRAL AVE STE 145
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2808
Mailing Address - Country:US
Mailing Address - Phone:623-583-3001
Mailing Address - Fax:623-974-6721
Practice Address - Street 1:9610 N METRO PKWY W
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85051-1402
Practice Address - Country:US
Practice Address - Phone:480-964-2273
Practice Address - Fax:602-843-1560
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2025-04-30
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Provider Licenses
StateLicense IDTaxonomies
AZ241373363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082436Medicaid