Provider Demographics
NPI:1912426248
Name:BAKER, TAMARA S (APRN, FNP-C)
Entity Type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:S
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 AMBERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7951
Mailing Address - Country:US
Mailing Address - Phone:803-917-1722
Mailing Address - Fax:
Practice Address - Street 1:166 MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITMIRE
Practice Address - State:SC
Practice Address - Zip Code:29178-1318
Practice Address - Country:US
Practice Address - Phone:803-805-0153
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21195363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily