Provider Demographics
NPI:1598129991
Name:BALDWIN, SHONNA P (ARNP)
Entity Type:Individual
Prefix:
First Name:SHONNA
Middle Name:P
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:SHONNA
Other - Middle Name:
Other - Last Name:PACZOSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-588-0325
Mailing Address - Fax:502-588-0326
Practice Address - Street 1:7335 GLADIOLUS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908
Practice Address - Country:US
Practice Address - Phone:239-985-1925
Practice Address - Fax:239-321-6044
Is Sole Proprietor?:No
Enumeration Date:2016-04-12
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3011809363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1248337OtherWELLCARE-MEDICARE/MEDICAID
FL017463500Medicaid
FL8846255OtherCIGNA
IN300012198Medicaid
FLP01723488OtherRR MEDICARE
FLP1046566OtherFREEDOM
FL398535OtherAVMED
FL4939267OtherAETNA
FLZNQDDOtherBCBS
FLP980558OtherOPTIMUM