Provider Demographics
NPI:1942551155
Name:BAILEY, LARA TRIPOLI (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LARA
Middle Name:TRIPOLI
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 FOREST GROVE DR
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9101
Mailing Address - Country:US
Mailing Address - Phone:860-819-7917
Mailing Address - Fax:
Practice Address - Street 1:52 FOREST GROVE DR
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-9101
Practice Address - Country:US
Practice Address - Phone:860-819-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11020883363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner