1952417842 NPI number — MRS. GLADYS MILDRED BAKER REGISTERED NURSE

Table of content: MRS. GLADYS MILDRED BAKER REGISTERED NURSE (NPI 1952417842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952417842 NPI number — MRS. GLADYS MILDRED BAKER REGISTERED NURSE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
GLADYS
Provider Middle Name:
MILDRED
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
REGISTERED NURSE
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TOMSHAW BAKER
Provider Other First Name:
GLADYS
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1952417842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 SE 32ND AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OCALA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-629-0137
Provider Business Practice Location Address Fax Number:
352-694-4824
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN1067352 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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