Provider Demographics
NPI:1770931099
Name:BAEZ, EMILY LYNN (MS AGACNP-BC)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:LYNN
Last Name:BAEZ
Suffix:
Gender:F
Credentials:MS AGACNP-BC
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:NEIGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS AGACNP-BC
Mailing Address - Street 1:384 AMWELL RD UNIT 508
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1280
Mailing Address - Country:US
Mailing Address - Phone:540-907-2745
Mailing Address - Fax:
Practice Address - Street 1:110 REHILL AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2519
Practice Address - Country:US
Practice Address - Phone:908-685-2200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-26
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1018223163W00000X
VA0001192950163W00000X
VA0024174292363LA2100X
NJ26NJ01023300363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024174292OtherVIRGINIA BOARD OF NURSING LICENSED NURSE PRACTITIONER