Provider Demographics
NPI:1053755017
Name:BARON, SOMMER (PA)
Entity type:Individual
Prefix:
First Name:SOMMER
Middle Name:
Last Name:BARON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SOMMER
Other - Middle Name:
Other - Last Name:MANERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:2868 S ALAFAYA TRL
Practice Address - Street 2:SUITE 130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7974
Practice Address - Country:US
Practice Address - Phone:407-770-0063
Practice Address - Fax:407-770-0129
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA - 9106896363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHE515ZMedicare PIN
FLHE515YMedicare PIN