MEDICARE: DR. NICHOLAS MARQUIS BAXTER

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	183500000X	Pharmacist	PS61250	FL

General Provider Information

NPI Number	:	1508477977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS MARQUIS BAXTER

Provider Business Mailing Address
First Line	:	1302 RIVER ST
Second Line	:
City	:	PALATKA
State	:	FL
Zip	:	32177-5042
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 DUNN AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-1439
Country	:	US
Telephone Number	:	386-323-9808
Fax Number	:

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

Provider Enumeration Date	:	08/11/2020
Last Update Date	:	02/19/2026

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