Provider Demographics
NPI:1235894064
Name:BAILEY, SHERINE DOMINIQUE (APRN)
Entity Type:Individual
Prefix:
First Name:SHERINE
Middle Name:DOMINIQUE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 W PRESERVE WAY APT 304
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3909
Mailing Address - Country:US
Mailing Address - Phone:954-822-5363
Mailing Address - Fax:
Practice Address - Street 1:2090 W PRESERVE WAY APT 304
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3909
Practice Address - Country:US
Practice Address - Phone:954-822-5363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-06
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11016243363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner