Provider Demographics
NPI:1346259066
Name:BAILEY, BOUGAINVILLA T (ARNP, CMN)
Entity Type:Individual
Prefix:MS
First Name:BOUGAINVILLA
Middle Name:T
Last Name:BAILEY
Suffix:
Gender:F
Credentials:ARNP, CMN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 UNIVERISTY BLVD. NORTH
Mailing Address - Street 2:MC 75
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211
Mailing Address - Country:US
Mailing Address - Phone:904-253-2062
Mailing Address - Fax:904-253-1942
Practice Address - Street 1:1760 EDGEWOOD AVE., WEST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32208
Practice Address - Country:US
Practice Address - Phone:904-253-1030
Practice Address - Fax:904-924-1773
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2013-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2164831367A00000X
FLARNP2164832367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3022021-00Medicaid
FL302202100Medicaid
FL302202100Medicaid
FLS64387Medicare UPIN
FLAB381YMedicare PIN
FL3022021-00Medicaid