Provider Demographics
NPI:1154643138
Name:BAKER, PATRICIA J (HAS)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:HAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 CORONA CT
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-9021
Mailing Address - Country:US
Mailing Address - Phone:386-597-2134
Mailing Address - Fax:386-579-2190
Practice Address - Street 1:1555 ATLANTIC BLVD
Practice Address - Street 2:
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-1717
Practice Address - Country:US
Practice Address - Phone:904-241-0327
Practice Address - Fax:904-241-0311
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-18
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAT 4622174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAT 4622OtherFLORIDA DEPARTMENT OF HEALTH