Provider Demographics
NPI:1033823919
Name:BUNNELL, BAILEY ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BAILEY
Middle Name:ROSE
Last Name:BUNNELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 BRIDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32257-5715
Mailing Address - Country:US
Mailing Address - Phone:904-945-1478
Mailing Address - Fax:
Practice Address - Street 1:2908 BRIDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5715
Practice Address - Country:US
Practice Address - Phone:904-945-1478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1189428363AM0700X
FLPA9116794363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical