Healthcare Provider Details

I. General information

NPI: 1790697100
Provider Name (Legal Business Name): JORDAN BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2237 SADNET LN
NORTH PORT FL
34286-0704
US

IV. Provider business mailing address

2237 SADNET LN
NORTH PORT FL
34286-0704
US

V. Phone/Fax

Practice location:
  • Phone: 239-223-2470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberAPRN11050817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: