Provider Demographics
NPI: | 1801864681 |
---|---|
Name: | BAKER, ELIZABETH HUNT (PA C) |
Entity Type: | Individual |
Prefix: | MRS |
First Name: | ELIZABETH |
Middle Name: | HUNT |
Last Name: | BAKER |
Suffix: | |
Gender: | F |
Credentials: | PA C |
Other - Prefix: | |
Other - First Name: | ELIZABETH |
Other - Middle Name: | ANN |
Other - Last Name: | HUNT |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | PA C |
Mailing Address - Street 1: | 303 N CLYDE MORRIS BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | DAYTONA BEACH |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 32114-2709 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 386-425-0141 |
Mailing Address - Fax: | 386-226-4577 |
Practice Address - Street 1: | 303 N CLYDE MORRIS BLVD |
Practice Address - Street 2: | |
Practice Address - City: | DAYTONA BEACH |
Practice Address - State: | FL |
Practice Address - Zip Code: | 32114-2709 |
Practice Address - Country: | US |
Practice Address - Phone: | 386-425-2285 |
Practice Address - Fax: | 386-425-7522 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-03-09 |
Last Update Date: | 2019-05-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | PA9101428 | 363A00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | S95424054 | Other | TRICARE |
FL | S95424054 | Other | TRICARE |
E4678A | Medicare ID - Type Unspecified |