Healthcare Provider Details

I. General information

NPI: 1407613417
Provider Name (Legal Business Name): ARYNA BAKER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2024
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1370 13TH AVE S STE 220
JACKSONVILLE BEACH FL
32250-3206
US

IV. Provider business mailing address

1443 SAN MARCO BLVD STE 101
JACKSONVILLE FL
32207-8535
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-6910
  • Fax: 904-253-6964
Mailing address:
  • Phone: 904-253-6910
  • Fax: 904-253-6964

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: