MEDICARE: MELISSA M BAILEY ARNP

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	363LF0000X	Family Nurse Practitioner	ARNP663562	FL
2	363L00000X	Nurse Practitioner	ARNP663562	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Y0155	OTHER	FL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1992793004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA M BAILEY ARNP

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-7770
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4202 E FOWLER AVE
Second Line	:	SHS100
City	:	TAMPA
State	:	FL
Zip	:	33620-6750
Country	:	US
Telephone Number	:	813-974-2331
Fax Number	:	813-974-5888

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	11/04/2014

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