Healthcare Provider Details

I. General information

NPI: 1376457358
Provider Name (Legal Business Name): TIANA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4417 CORPORATION LN STE 300
VIRGINIA BEACH VA
23462-3477
US

IV. Provider business mailing address

1365 BATTLEFORD DR
VIRGINIA BEACH VA
23464-8667
US

V. Phone/Fax

Practice location:
  • Phone: 757-785-3338
  • Fax:
Mailing address:
  • Phone: 757-768-8195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: