Provider Demographics
NPI:1336146380
Name:BAXLEY, KAREN F (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:F
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1070 N STONE ST STE A
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-0824
Mailing Address - Country:US
Mailing Address - Phone:386-943-7100
Mailing Address - Fax:386-943-8909
Practice Address - Street 1:1070 N STONE ST STE A
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-0824
Practice Address - Country:US
Practice Address - Phone:386-943-7100
Practice Address - Fax:386-943-8909
Is Sole Proprietor?:No
Enumeration Date:2005-07-06
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101937363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP59196Medicare UPIN