Provider Demographics
NPI:1407246630
Name:BAKER, HOLLY J (PA-C)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:13510 SAW PALM CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-2610
Mailing Address - Country:US
Mailing Address - Phone:716-622-2166
Mailing Address - Fax:941-365-2269
Practice Address - Street 1:1901 FLOYD ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-2932
Practice Address - Country:US
Practice Address - Phone:941-366-9222
Practice Address - Fax:941-365-2269
Is Sole Proprietor?:No
Enumeration Date:2015-01-26
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY023494-1363AM0700X
FLPA9117261363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical