Provider Demographics
NPI:1477749794
Name:BAILEY, TARA (LPN)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DRAGSTON RD
Mailing Address - Street 2:
Mailing Address - City:PORT NORRIS
Mailing Address - State:NJ
Mailing Address - Zip Code:08349-2508
Mailing Address - Country:US
Mailing Address - Phone:800-950-6066
Mailing Address - Fax:
Practice Address - Street 1:1112 DRAGSTON RD
Practice Address - Street 2:
Practice Address - City:PORT NORRIS
Practice Address - State:NJ
Practice Address - Zip Code:08349-2508
Practice Address - Country:US
Practice Address - Phone:800-950-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NP05684200164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse