MEDICARE: MRS. DEBRA LYNN BAKER

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	372600000X	Adult Companion		FL

General Provider Information

NPI Number	:	1760445811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA LYNN BAKER

Provider Business Mailing Address
First Line	:	3007 FOLSOM RD
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754-2901
Country	:	US
Telephone Number	:	321-385-0157
Fax Number	:	321-385-0157

Provider Business Practice Location Address
First Line	:	4255 DIXIE WAY
Second Line	:
City	:	MIMS
State	:	FL
Zip	:	32754-5150
Country	:	US
Telephone Number	:	321-267-7897
Fax Number	:

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

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	07/09/2007

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