Healthcare Provider Details

I. General information

NPI: 1265611966
Provider Name (Legal Business Name): SONJA RENAE BAER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 UNIVERSITY PKWY STE 302
SARASOTA FL
34240-9048
US

IV. Provider business mailing address

6000 UNIVERSITY AVE STE 450
WEST DES MOINES IA
50266-8229
US

V. Phone/Fax

Practice location:
  • Phone: 941-800-5001
  • Fax: 941-800-5012
Mailing address:
  • Phone: 515-241-2000
  • Fax: 515-241-2005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9118914
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number001863
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: