Provider Demographics
NPI:1851712764
Name:BAKARR, EDDITA B (MSN, FNP)
Entity Type:Individual
Prefix:
First Name:EDDITA
Middle Name:B
Last Name:BAKARR
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1261 ROUTE 38
Mailing Address - Street 2:SUITE A
Mailing Address - City:HAINESPORT
Mailing Address - State:NJ
Mailing Address - Zip Code:08036-2702
Mailing Address - Country:US
Mailing Address - Phone:856-222-1975
Mailing Address - Fax:856-222-0721
Practice Address - Street 1:1261 ROUTE 38
Practice Address - Street 2:SUITE A
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2702
Practice Address - Country:US
Practice Address - Phone:856-222-1975
Practice Address - Fax:856-222-0721
Is Sole Proprietor?:No
Enumeration Date:2013-12-18
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00474700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ336039AB5Medicare PIN