Provider Demographics
NPI:1467458935
Name:BAKER, SUSAN ARLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ARLENE
Last Name:BAKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100707
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0707
Mailing Address - Country:US
Mailing Address - Phone:305-434-1400
Mailing Address - Fax:
Practice Address - Street 1:5701 OVERSEAS HWY STE 17
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2784
Practice Address - Country:US
Practice Address - Phone:305-434-1400
Practice Address - Fax:305-743-0962
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9390424363LF0000X
FLARPN9390424363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200937280Medicaid
IN62610002OtherPTAN
INM400037091Medicare PIN