Provider Demographics
NPI:1952351173
Name:BAER, JACQUELINE L (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:L
Last Name:BAER
Suffix:
Gender:F
Credentials: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:PO BOX 336
Mailing Address - Street 2:
Mailing Address - City:JOHNS ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29457-0336
Mailing Address - Country:US
Mailing Address - Phone:843-559-1938
Mailing Address - Fax:843-557-1998
Practice Address - Street 1:1816 BOHICKET RD
Practice Address - Street 2:SUITE F
Practice Address - City:JOHNS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29455-3318
Practice Address - Country:US
Practice Address - Phone:843-559-1938
Practice Address - Fax:843-557-1998
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1396363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3367Medicaid
SCGP3367Medicaid
SCP402940281Medicare UPIN