Provider Demographics
NPI:1710346457
Name:BAKER, TAMMY (CNA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 W COLGATE DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2704
Mailing Address - Country:US
Mailing Address - Phone:949-300-3404
Mailing Address - Fax:
Practice Address - Street 1:810 W COLGATE DR
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-2704
Practice Address - Country:US
Practice Address - Phone:949-300-3404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-22
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZL20073346251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health