Healthcare Provider Details

I. General information

NPI: 1033098207
Provider Name (Legal Business Name): NINA BAKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2025
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 S ABERDEENSHIRE DR
FRUIT COVE FL
32259-6926
US

IV. Provider business mailing address

522 S ABERDEENSHIRE DR
FRUIT COVE FL
32259-6926
US

V. Phone/Fax

Practice location:
  • Phone: 850-345-1255
  • Fax:
Mailing address:
  • Phone: 850-345-1255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9522952
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: