Healthcare Provider Details

I. General information

NPI: 1912662982
Provider Name (Legal Business Name): BAILEY ELIZABETH FLORIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2021
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL FL 2
CELEBRATION FL
34747-4606
US

IV. Provider business mailing address

380 CELEBRATION PL
CELEBRATION FL
34747-4606
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4190
  • Fax:
Mailing address:
  • Phone: 407-303-4190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9115284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: