Provider Demographics
NPI:1437300373
Name:KING, JANET BAKER (APRN-BC)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:BAKER
Last Name:KING
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:JANET
Other - Middle Name:LYNN
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN-BC
Mailing Address - Street 1:1112 SAN ANTONIO LN
Mailing Address - Street 2:
Mailing Address - City:LADY LAKE
Mailing Address - State:FL
Mailing Address - Zip Code:32159-9306
Mailing Address - Country:US
Mailing Address - Phone:954-257-6911
Mailing Address - Fax:
Practice Address - Street 1:1112 SAN ANTONIO LN
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-9306
Practice Address - Country:US
Practice Address - Phone:352-633-1709
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-09
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1870602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV736ZMedicare PIN