Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 6172 | FL |
Y | 103TC0700X | Clinical Psychologist | 6172 | FL |
NPI | 1003926288 |
---|---|
Provider Name | Dr. Theresa E Baker |
First Address | Fernandina Beach, FL 32034-3936 |
Second Address | Fernandina Beach, FL 32034-3936 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
75324 | BXBS - FL (01) | FL |