Provider Demographics
NPI:1023395944
Name:BAILEY, TRICIANNA S (LPN, RN)
Entity type:Individual
Prefix:
First Name:TRICIANNA
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:F
Credentials:LPN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 PATCHOGUE AVE
Mailing Address - Street 2:
Mailing Address - City:MASTIC
Mailing Address - State:NY
Mailing Address - Zip Code:11950-3623
Mailing Address - Country:US
Mailing Address - Phone:631-772-7014
Mailing Address - Fax:
Practice Address - Street 1:126 PATCHOGUE AVE
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950-3623
Practice Address - Country:US
Practice Address - Phone:631-772-7014
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-06
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY285165164W00000X
NY659119163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No163W00000XNursing Service ProvidersRegistered Nurse