Healthcare Provider Details

I. General information

NPI: 1851226278
Provider Name (Legal Business Name): KEIRA BAKER SKN WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37689 LEAFSIDE LN
ZEPHYRHILLS FL
33541-3804
US

IV. Provider business mailing address

7901 4TH ST N # 28048
ST PETERSBURG FL
33702-4305
US

V. Phone/Fax

Practice location:
  • Phone: 813-606-8110
  • Fax:
Mailing address:
  • Phone: 813-510-5717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KEIRA QUEINISE RANDALL
Title or Position: NURSE PRACTITIONER/OWNER
Credential: NP
Phone: 813-510-5717