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General NPI Number Information
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NPI Number | 1568804011
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Entity Type | Individual
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Provider Name | MERLAND ANTHONY BAKER M.S.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 10/24/2019
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Provider Practice Location Address
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Address Line | 6034 CHESTER AVE STE 205
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City | JACKSONVILLE
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State | FL
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Zip | 32217-2266
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Country | US
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Telephone | 904-566-1955
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Fax | 904-323-0469
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Provider Business Mailing Address
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Address Line | 3452 LIVE OAK HOLLOW DR
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City | ORANGE PARK
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State | FL
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Zip | 32065-2525
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Country | US
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Telephone | 904-566-1955
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH15468
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License Number State | FL
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