Provider Demographics
NPI:1255322673
Name:BAILEY, PATRICIA M (MS, FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MS, FNP-BC
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:GLIDDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, FNP-BC
Mailing Address - Street 1:8437 VIA MALLORCA UNIT 83
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-2612
Mailing Address - Country:US
Mailing Address - Phone:619-417-3747
Mailing Address - Fax:
Practice Address - Street 1:1428 HIGHLAND AVE
Practice Address - Street 2:OPERATION SAMAHAN
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-4624
Practice Address - Country:US
Practice Address - Phone:619-477-4450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR133144OtherGROUP PIN
ORP55046Medicare UPIN
OR133119Medicare PIN