MEDICARE: MRS. GLADYS MILDRED BAKER REGISTERED NURSE

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	163W00000X	Registered Nurse	RN1067352	FL

General Provider Information

NPI Number	:	1952417842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLADYS MILDRED BAKER REGISTERED NURSE

Provider Business Mailing Address
First Line	:	PO BOX 1594
Second Line	:
City	:	BELLEVIEW
State	:	FL
Zip	:	34421-1594
Country	:	US
Telephone Number	:	352-629-0137
Fax Number	:	352-694-4824

Provider Business Practice Location Address
First Line	:	1801 SE 32ND AVE
Second Line	:
City	:	OCALA
State	:	FL
Zip	:	34478
Country	:	US
Telephone Number	:	352-629-0137
Fax Number	:	352-694-4824

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

Provider Enumeration Date	:	08/22/2006
Last Update Date	:	07/08/2007

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