Provider Demographics
NPI:1316903370
Name:BAKER, IVETTE ILIANA (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:ILIANA
Last Name:BAKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:8300 SW 172ND ST
Mailing Address - Street 2:
Mailing Address - City:VILLAGE OF PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4737
Mailing Address - Country:US
Mailing Address - Phone:305-255-7365
Mailing Address - Fax:305-259-3944
Practice Address - Street 1:9250 WEST FLAGLER ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:305-552-2342
Practice Address - Fax:305-552-2099
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLRN 2112442363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health