Healthcare Provider Details

I. General information

NPI: 1881208593
Provider Name (Legal Business Name): AARON BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2020
Last Update Date: 09/01/2020
Certification Date: 09/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14546 OLD SAINT AUGUSTINE RD
JACKSONVILLE FL
32258-5468
US

IV. Provider business mailing address

799 ASHTON LAKES BLVD
PORT ORANGE FL
32128-6066
US

V. Phone/Fax

Practice location:
  • Phone: 904-720-0799
  • Fax:
Mailing address:
  • Phone: 386-405-8133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN9398631
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: