Healthcare Provider Details

I. General information

NPI: 1861980724
Provider Name (Legal Business Name): CLORINDA M BAKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4451 BAYOU BLVD
PENSACOLA FL
32503-2601
US

IV. Provider business mailing address

2115 CHANCE RD
MOLINO FL
32577-7083
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-7619
  • Fax:
Mailing address:
  • Phone: 850-529-0638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number65649
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number65649
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number9343863
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number9343863
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: