Provider Demographics
NPI:1093451825
Name:BAILEY- MASON, JODY PATRICE
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:PATRICE
Last Name:BAILEY- MASON
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 1:1824 HONEYDEW CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-7705
Mailing Address - Country:US
Mailing Address - Phone:407-968-7777
Mailing Address - Fax:
Practice Address - Street 1:1824 HONEYDEW CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-7705
Practice Address - Country:US
Practice Address - Phone:407-968-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-05
Last Update Date:2024-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X
FL239679376J00000X
FLPN5263457164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No376J00000XNursing Service Related ProvidersHomemakerGroup - Multi-Specialty