Provider Demographics
NPI:1518501832
Name:BAKER, AMANDA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6936 CYPRESS SPRING CT
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4818
Mailing Address - Country:US
Mailing Address - Phone:904-248-8212
Mailing Address - Fax:
Practice Address - Street 1:3901 UNIVERSITY BLVD S STE 221
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4392
Practice Address - Country:US
Practice Address - Phone:904-423-0010
Practice Address - Fax:904-423-0012
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11004445363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily