Provider Demographics
NPI:1588075196
Name:BAILEY, VIVIANNE
Entity type:Individual
Prefix:
First Name:VIVIANNE
Middle Name:
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 1:15701 NW 37TH AVE
Mailing Address - Street 2:024981596
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33054-6373
Mailing Address - Country:US
Mailing Address - Phone:305-200-8927
Mailing Address - Fax:
Practice Address - Street 1:15701 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33054-6373
Practice Address - Country:US
Practice Address - Phone:305-200-8927
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL024981596Medicaid