Healthcare Provider Details

I. General information

NPI: 1932011640
Provider Name (Legal Business Name): JENNIFER LAURIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 SW ALACHUA AVE
LAKE CITY FL
32025-5213
US

IV. Provider business mailing address

444 SW ALACHUA AVE
LAKE CITY FL
32025-5213
US

V. Phone/Fax

Practice location:
  • Phone: 386-719-5656
  • Fax:
Mailing address:
  • Phone: 386-719-5656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA80535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: