Healthcare Provider Details

I. General information

NPI: 1992793004
Provider Name (Legal Business Name): MELISSA M BAILEY ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4202 E FOWLER AVE SHS100
TAMPA FL
33620-6750
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2331
  • Fax: 813-974-5888
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP663562
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP663562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: