Provider Demographics
NPI:1063902435
Name:BAILEY, CORIE L
Entity type:Individual
Prefix:
First Name:CORIE
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 WHISPER WIND LN
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-5131
Mailing Address - Country:US
Mailing Address - Phone:727-534-2040
Mailing Address - Fax:
Practice Address - Street 1:1815 HEALTH CARE DR STE B
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5363
Practice Address - Country:US
Practice Address - Phone:727-312-4445
Practice Address - Fax:727-312-4643
Is Sole Proprietor?:No
Enumeration Date:2018-05-11
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9292967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily