Heather Danielle Bautista

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1255 Issued in CO

Practice address

340 Magnolia Cir
Tyndall Afb, FL 32403-5604

Phone

(850) 283-7511

NPI assigned

Jun 22, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367280000000",
    "number": "1497951917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9902 S THOMAS DR",
            "address_2": "UNIT 1333",
            "city": "PANAMA CITY BEACH",
            "state": "FL",
            "postal_code": "324081201",
            "telephone_number": "707-290-8444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 MAGNOLIA CIR",
            "city": "TYNDALL AFB",
            "state": "FL",
            "postal_code": "324035604",
            "telephone_number": "850-283-7511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAUTISTA",
        "first_name": "HEATHER",
        "middle_name": "DANIELLE",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-22",
        "last_updated": "2013-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CO",
            "license": "1255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 325TH Medical Group
• Nicholas S. Appleman, O.D.
• Dylan Baker, MD
• Donna Jane Bates
• Oliver Henry Bauer, PSYD
• Rama Bhyravabhotla, PA-C
• Gabrielle Kelly Blankenship, LCSW
• Mandy Lynn Boatright
• Stephanie Salyn Bond, PSYD
• Raywood W Borel, PHARM.D.

• Clinical Social Worker in Tyndall Afb, FL
• Providers in Tyndall Afb, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.