Provider Demographics
NPI:1346904026
Name:BAKER, OPAL ANNETTE (FNP)
Entity Type:Individual
Prefix:MS
First Name:OPAL
Middle Name:ANNETTE
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1695 EASTCHESTER RD FL 2
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2375
Mailing Address - Country:US
Mailing Address - Phone:718-405-8505
Mailing Address - Fax:
Practice Address - Street 1:1695 EASTCHESTER RD FL 2
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2375
Practice Address - Country:US
Practice Address - Phone:718-405-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-28
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347437363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily