Most Relevant Information
Provider Data
| NPI Number: | 1003514985 |
| Provider Name: | ANGELIQUE BAUTISTA GABAT FNP-C |
| Entity Type: | Individual |
| Taxonomy Code: | 363LF0000X |
| Specialty: | Nurse Practitioner |
| License Number: | 209026819 |
Most Important Dates
| Enumeration Date: | 02/20/2023 |
| Last Updated: | 09/25/2024 |
Provider Practice Location
2300 N EDWARD ST STE 2400
DECATUR
IL
625264163
Practice Location Phone/Fax
| Phone: | 2178762400 |
| Fax: | 2178762405 |
Provider Mailing Location
2300 N EDWARD ST STE 2400
DECATUR
IL
625264163
Provider Mailing Phone/Fax
| Phone: | 2178762400 |
| Fax: | 2178762405 |