Provider Demographics
NPI:1285936500
Name:BAKER, CRYSTAL (FNP)
Entity type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 E LITTLE CREEK RD STE D&E
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-3460
Mailing Address - Country:US
Mailing Address - Phone:757-337-8501
Mailing Address - Fax:757-210-4129
Practice Address - Street 1:3520 E LITTLE CREEK RD STE D&E
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23518-3460
Practice Address - Country:US
Practice Address - Phone:757-337-8501
Practice Address - Fax:757-210-4129
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168930363L00000X, 363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVV4373AMedicare PIN