MEDICARE: MRS. BONITA LYNN BAILEY ARNP

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
1	363LF0000X	Family Nurse Practitioner	ARNP 2178572	FL

General Provider Information

NPI Number	:	1639289622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONITA LYNN BAILEY ARNP

Provider Business Mailing Address
First Line	:	22345 KINGSLEY LN
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-4642
Country	:	US
Telephone Number	:	813-996-8534
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 E SLIGH AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33604-5636
Country	:	US
Telephone Number	:	813-237-6988
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	01/09/2014

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