MEDICARE: MRS. KAREN F BAXLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA9101937	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336146380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN F BAXLEY PA-C

Provider Business Mailing Address
First Line	:	1070 N STONE ST STE A
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-7100
Fax Number	:	386-943-8909

Provider Business Practice Location Address
First Line	:	1070 N STONE ST STE A
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32720-0824
Country	:	US
Telephone Number	:	386-943-7100
Fax Number	:	386-943-8909

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2005
Last Update Date	:	02/20/2020

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