Provider Demographics
NPI:1144927989
Name:BAKER, JAMIE RENEE (CPHT, PACS)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:RENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CPHT, PACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2722 WOOD STORK TRL
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-1667
Mailing Address - Country:US
Mailing Address - Phone:910-264-6275
Mailing Address - Fax:904-541-0316
Practice Address - Street 1:2722 WOOD STORK TRL
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-1667
Practice Address - Country:US
Practice Address - Phone:910-264-6275
Practice Address - Fax:904-541-0316
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT68391183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183700000XPharmacy Service ProvidersPharmacy TechnicianGroup - Single Specialty