Provider Demographics
NPI:1407856123
Name:TRIOLO-BONE, JAIME LEIGH (APRN)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LEIGH
Last Name:TRIOLO-BONE
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 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:7125 MURRELL RD STE E
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7999
Practice Address - Country:US
Practice Address - Phone:321-434-9571
Practice Address - Fax:321-434-9275
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-22
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9166430363LW0102X, 363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU1250YOtherMEDICARE
FL104937800Medicaid