MEDICARE: CHRISSY JO BAKER APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	28220234A	IN
2	363LF0000X	Family Nurse Practitioner	APRN11015248	FL

General Provider Information

NPI Number	:	1760011605
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISSY JO BAKER APRN

Provider Business Mailing Address
First Line	:	2675 WINKLER AVE FL 2
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9342
Country	:	US
Telephone Number	:	877-856-3774
Fax Number	:	239-599-4126

Provider Business Practice Location Address
First Line	:	15201 N CLEVELAND AVE STE 1010
Second Line	:
City	:	NORTH FORT MYERS
State	:	FL
Zip	:	33903-2717
Country	:	US
Telephone Number	:	833-674-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	05/06/2024

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