Provider Demographics
NPI:1023621596
Name:BAILEY, JASON JOHN (APRN)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:JOHN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2853 HENLEY RD STE 103
Mailing Address - Street 2:
Mailing Address - City:GREEN COVE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32043-8616
Mailing Address - Country:US
Mailing Address - Phone:046-024-5109
Mailing Address - Fax:904-602-4519
Practice Address - Street 1:2853 HENLEY RD STE 103
Practice Address - Street 2:
Practice Address - City:GREEN COVE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32043-8616
Practice Address - Country:US
Practice Address - Phone:904-602-4510
Practice Address - Fax:904-602-4519
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11007519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily