Healthcare Provider Details

I. General information

NPI: 1225331945
Provider Name (Legal Business Name): TIMOTHY S BAILEY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2010
Last Update Date: 01/18/2023
Certification Date: 01/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1839 HEALTH CARE DR
TRINITY FL
34655-5363
US

IV. Provider business mailing address

1839 HEALTH CARE DR
TRINITY FL
34655-5363
US

V. Phone/Fax

Practice location:
  • Phone: 727-312-4445
  • Fax:
Mailing address:
  • Phone: 727-312-4445
  • Fax: 727-312-4643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number7784
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS7784
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: