Basic Information
Provider Information
NPI: 1215489430
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAEZ
FirstName: NGOZI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: AGPCNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Practice Location
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Other Information
ProviderEnumerationDate: 11/04/2016
LastUpdateDate: 03/23/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X9207408FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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