Individual
TIFFANY NICOLE BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
112 N BROAD ST, PHILADELPHIA, PA 19102-1512
(215) 568-0860
Mailing address
112 N BROAD ST, PHILADELPHIA, PA 19102-1512
(215) 568-0860
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN311867
PA
Other
Enumeration date
09/09/2021
Last updated
09/09/2021
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