Individual
JESSICA BAILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637
(813) 871-8200
(813) 357-5501
Mailing address
12470 TELECOM DR STE 300W, TEMPLE TERRACE, FL 33637-0904
(813) 871-8200
(813) 357-5501
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
APRN9206590
FL
363LA2200X
Adult Health Nurse Practitioner
ARNP9206590
FL
363LG0600X
Gerontology Nurse Practitioner
APRN9206590
FL
363LP2300X
Primary Care Nurse Practitioner
ARNP9206590
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
023487400
—
FL
01
—
85P4Y
BCBS
FL
01
—
APRN9206590
APRN LICENSE
FL
01
—
P02212317
RAILROAD MEDICARE
FL
Enumeration date
03/13/2017
Last updated
03/07/2023
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