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NPI Code Detail

MEDICARE: BAILEY J RUSSELL

MEDICARE: BAILEY J RUSSELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1163W00000XRegistered Nurse9570449FL

General Provider Information

NPI Number : 1629851787
Entity Type Code : Individual
Provider Name (Legal Business Name) : BAILEY J RUSSELL
Provider Business Mailing Address
First Line : 9885 MAR LARGO CIR
Second Line :
City : FORT MYERS
State : FL
Zip : 33919-7326
Country : US
Telephone Number : 239-989-8523
Fax Number :
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3620
Country : US
Telephone Number : 239-343-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2023
Last Update Date : 08/14/2023

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Directions to “ BAILEY J RUSSELL ” Practice Location

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