Provider Demographics
NPI:1316502735
Name:BAILEY, TABITHA LEONDRA
Entity type:Individual
Prefix:MS
First Name:TABITHA
Middle Name:LEONDRA
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 1:1710 KENDRICK LN
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-2506
Mailing Address - Country:US
Mailing Address - Phone:863-262-8857
Mailing Address - Fax:863-284-1070
Practice Address - Street 1:1710 KENDRICK LN
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-2506
Practice Address - Country:US
Practice Address - Phone:863-262-8857
Practice Address - Fax:863-284-1070
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-01
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X, 251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty