Provider Demographics
NPI:1174870646
Name:ROSE-BAXTER, LLOYDA MAXINE (MSN, ANP-,RN-BC, CCM)
Entity type:Individual
Prefix:
First Name:LLOYDA
Middle Name:MAXINE
Last Name:ROSE-BAXTER
Suffix:
Gender:F
Credentials:MSN, ANP-,RN-BC, CCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:557 ZINFANDEL CT
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5037
Mailing Address - Country:US
Mailing Address - Phone:407-765-3130
Mailing Address - Fax:407-877-7362
Practice Address - Street 1:557 ZINFANDEL CT
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5037
Practice Address - Country:US
Practice Address - Phone:407-877-7362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-14
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9180759163W00000X
FLARNP9180759363LA2200X
FL2011001242163WC0400X
FL2010010110163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIB124ZMedicare UPIN