Healthcare Provider Details

I. General information

NPI: 1629851787
Provider Name (Legal Business Name): BAILEY J RUSSELL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2023
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9981 S HEALTHPARK DR
FORT MYERS FL
33908-3620
US

IV. Provider business mailing address

9885 MAR LARGO CIR
FORT MYERS FL
33919-7326
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-5000
  • Fax:
Mailing address:
  • Phone: 239-989-8523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11048337
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9570449
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: