Healthcare Provider Details

I. General information

NPI: 1285932483
Provider Name (Legal Business Name): ANGELA MARIE BAILEY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2011
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 UNIVERSITY BLVD S STE 203
JACKSONVILLE FL
32216-4389
US

IV. Provider business mailing address

971 AUTUMN PINES DR
ORANGE PARK FL
32065-2688
US

V. Phone/Fax

Practice location:
  • Phone: 904-731-0085
  • Fax:
Mailing address:
  • Phone: 904-307-7087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberAPRN9242507
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: