Healthcare Provider Details

I. General information

NPI: 1952225674
Provider Name (Legal Business Name): TATILLIA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3555 PINE RIDGE CT
ORLANDO FL
32808-2875
US

IV. Provider business mailing address

3555 PINE RIDGE CT
ORLANDO FL
32808-2875
US

V. Phone/Fax

Practice location:
  • Phone: 407-728-2729
  • Fax:
Mailing address:
  • Phone: 407-728-2729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License NumberL26000393374
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberL26000393374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: