Provider Demographics
NPI:1932185675
Name:BAKER, HOLLY SPENCE (CNM)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:SPENCE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 SE 24TH STREET
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471
Mailing Address - Country:US
Mailing Address - Phone:352-368-2238
Mailing Address - Fax:352-368-5042
Practice Address - Street 1:324 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5362
Practice Address - Country:US
Practice Address - Phone:352-368-2238
Practice Address - Fax:352-368-5042
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9380943367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013495000Medicaid
FLHX327ZMedicare PIN