Provider Demographics
NPI:1942719463
Name:BAKER, NICOLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 BARRY AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4424
Mailing Address - Country:US
Mailing Address - Phone:203-313-4016
Mailing Address - Fax:
Practice Address - Street 1:1 AYRES CIRCLE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:AA
Practice Address - Zip Code:03807
Practice Address - Country:US
Practice Address - Phone:207-438-5975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-27
Last Update Date:2017-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant