Provider Demographics
NPI:1447806047
Name:BAZAN, SABRINA NICOLE (FNP)
Entity type:Individual
Prefix:MS
First Name:SABRINA
Middle Name:NICOLE
Last Name:BAZAN
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 N SAN PEDRO ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2301 ROBESON ST STE 203
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28305-5641
Practice Address - Country:US
Practice Address - Phone:910-615-3220
Practice Address - Fax:910-486-2170
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-11
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM57154363LF0000X
NC5021777363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily