Provider Demographics
NPI:1396488094
Name:BAYLESS, CARLY ELENA (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:ELENA
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HENDERSON BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5021
Mailing Address - Country:US
Mailing Address - Phone:813-279-1201
Mailing Address - Fax:850-655-1295
Practice Address - Street 1:4019 W EL PRADO BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8524
Practice Address - Country:US
Practice Address - Phone:813-753-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2025-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9514103163W00000X
FL11020198363LF0000X
CO0004242-C-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty