Healthcare Provider Details

I. General information

NPI: 1700260346
Provider Name (Legal Business Name): TAMMY J BAKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2015
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 PALERMO PL
VENICE FL
34285-2821
US

IV. Provider business mailing address

209 PALERMO PL
VENICE FL
34285-2821
US

V. Phone/Fax

Practice location:
  • Phone: 941-488-1906
  • Fax: 941-244-9326
Mailing address:
  • Phone: 941-488-1906
  • Fax: 941-244-9326

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP2731292
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: