Provider Demographics
NPI:1376261503
Name:BAKER, MALACHI III (HEALTH CARE PROVIDER)
Entity Type:Individual
Prefix:MR
First Name:MALACHI
Middle Name:
Last Name:BAKER
Suffix:III
Gender:M
Credentials:HEALTH CARE PROVIDER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 EAST CAYUGA ST
Mailing Address - Street 2:SAME ABOVE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33610-6025
Mailing Address - Country:US
Mailing Address - Phone:813-306-0618
Mailing Address - Fax:
Practice Address - Street 1:1717 EAST CAYUGA ST
Practice Address - Street 2:SAME ABOVE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33610
Practice Address - Country:US
Practice Address - Phone:813-475-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL883599704OtherHOME HEALTH CARE PROVIDER