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
StateLicense IDTaxonomies
FLPA9101428363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS95424054OtherTRICARE
FLS95424054OtherTRICARE
E4678AMedicare ID - Type Unspecified