Provider Demographics
NPI:1073279733
Name:BAILEY MANFREDI, LYNDI BROOKE (CRNA APRN)
Entity Type:Individual
Prefix:
First Name:LYNDI
Middle Name:BROOKE
Last Name:BAILEY MANFREDI
Suffix:
Gender:F
Credentials:CRNA APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 SONOMA COAST DR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-8457
Mailing Address - Country:US
Mailing Address - Phone:678-381-9652
Mailing Address - Fax:
Practice Address - Street 1:200 AVENUE F NE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4193
Practice Address - Country:US
Practice Address - Phone:863-293-1121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-16
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9575878163WC0200X
FLAPRN11030357367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11030357OtherFLORIDA BOARD OF NURSING
FLRN9575878OtherFLORIDA BOARD OF NURSING