Provider Demographics
NPI:1023165875
Name:BAKER MESA, KAREN (PA)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BAKER MESA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 SW 104TH ST
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-3149
Mailing Address - Country:US
Mailing Address - Phone:305-279-7546
Mailing Address - Fax:305-669-1362
Practice Address - Street 1:7700 SW 104TH ST
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-3149
Practice Address - Country:US
Practice Address - Phone:305-279-7546
Practice Address - Fax:305-669-1362
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 3609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant