Provider Demographics
NPI:1508071515
Name:BAKER, TRACEY L (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:L
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 1:202 LARCOM LN
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4905
Mailing Address - Country:US
Mailing Address - Phone:770-227-7559
Mailing Address - Fax:
Practice Address - Street 1:522 GREENWOOD ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30204-1554
Practice Address - Country:US
Practice Address - Phone:707-872-3663
Practice Address - Fax:707-872-3665
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2023-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN097754207Q00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine