Provider Demographics
NPI:1467932525
Name:BAKER, LISA (ARNP FNP-BC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:ARNP FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3156 CALGARY ST
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-4639
Mailing Address - Country:US
Mailing Address - Phone:321-374-4785
Mailing Address - Fax:
Practice Address - Street 1:3156 CALGARY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-4639
Practice Address - Country:US
Practice Address - Phone:321-374-4785
Practice Address - Fax:321-732-4942
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-17
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2929342363LF0000X
FL2929342207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily