MEDICARE: JACQUELINE BAZEMORE

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	225700000X	Massage Therapist	MA98391	FL

General Provider Information

NPI Number	:	1134070972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BAZEMORE

Provider Business Mailing Address
First Line	:	1880 AVENUE Q SW
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33880-6529
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6362 CYPRESS GARDENS BLVD
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33884-3176
Country	:	US
Telephone Number	:	863-320-0617
Fax Number	:

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

Provider Enumeration Date	:	02/06/2026
Last Update Date	:	02/06/2026

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Directions to “ JACQUELINE BAZEMORE ” Practice Location

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