Provider Demographics
NPI:1003706714
Name:BAKER, MELINDA JO (MSN, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MELINDA
Middle Name:JO
Last Name:BAKER
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 CAPRI DR
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32176-2233
Mailing Address - Country:US
Mailing Address - Phone:937-408-0094
Mailing Address - Fax:
Practice Address - Street 1:159 CAPRI DR
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32176-2233
Practice Address - Country:US
Practice Address - Phone:937-408-0094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-04
Last Update Date:2025-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040635363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner