Provider Demographics
NPI:1164239968
Name:BAXTER, MATTHEW ROBERT (RN)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROBERT
Last Name:BAXTER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:381 PALM COAST PKWY SW UNIT 2
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4782
Mailing Address - Country:US
Mailing Address - Phone:386-232-8089
Mailing Address - Fax:
Practice Address - Street 1:381 PALM COAST PKWY SW UNIT 2
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4782
Practice Address - Country:US
Practice Address - Phone:386-232-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9287274163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse