Individual provider Active NPI

Nicole Baker, CPNP-PC

  • Pediatric Nurse Practitioner
  • Norfolk, VA
National Provider Identifier
1104469733
Registry record updated Oct 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
0024176636 Issued in VA
Practice address
601 Childrens LN
Norfolk, VA 23507-1971
Phone
(757) 668-7703
Fax
(757) 668-8860
NPI assigned
Oct 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 0024176636 VA Primary

Addresses

Primary practice location

601 Childrens LN
Norfolk, VA 23507-1971

Mailing address

601 Childrens LN
Norfolk, VA 23507-1971
Phone (757) 668-7703

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220204001464 VA Practitioner - Nurse Practitioner 2264825769 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024176636VAMDPediatric Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Surgical Specialty Group, Inc CurrentSince Aug 26, 2021 Accepting new patients

Locations

11783 Rock Landing Dr
Newport News, VA 23606
Phone (757) 668-6550

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

2021 Concert Dr
Virginia Beach, VA 23456
Phone (757) 668-6550

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1572134400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1572134400000",
    "number": "1104469733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071971",
            "telephone_number": "757-668-7703",
            "fax_number": "757-668-8860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071971",
            "telephone_number": "757-668-7703",
            "fax_number": "757-668-8860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "NICOLE",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-27",
        "last_updated": "2019-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "VA",
            "license": "0024176636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.