Provider Demographics
NPI:1316916414
Name:BAKER, JOYCE A (CRNA)
Entity type:Individual
Prefix:MS
First Name:JOYCE
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 N VENETIAN WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-5710
Mailing Address - Country:US
Mailing Address - Phone:386-931-2863
Mailing Address - Fax:
Practice Address - Street 1:401 PALMETTO ST
Practice Address - Street 2:BERT FISH MEDICAL CENTER
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7322
Practice Address - Country:US
Practice Address - Phone:386-424-5025
Practice Address - Fax:386-424-5054
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1736572367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG2203VMedicare ID - Type Unspecified