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General NPI Number Information
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NPI Number | 1942004726
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Entity Type | Individual
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Provider Name | BAILEY GOGIA PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/02/2025
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 795 PRIMERA BLVD STE 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-2191
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Country | US
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Telephone | 386-561-9967
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Fax |
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Provider Business Mailing Address
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Address Line | 725 PRIMERA BLVD STE 220
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City | LAKE MARY
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State | FL
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Zip | 32746-2127
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Country | US
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Telephone | 386-561-9967
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 9119956
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License Number State | FL
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