Provider Demographics
NPI:1629510193
Name:BALDWIN, TATHYANA (ARNP)
Entity Type:Individual
Prefix:
First Name:TATHYANA
Middle Name:
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12989 PALMS WEST DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470
Mailing Address - Country:US
Mailing Address - Phone:561-459-8078
Mailing Address - Fax:
Practice Address - Street 1:12989 PALMS WEST DR.
Practice Address - Street 2:SUITE 200
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4989
Practice Address - Country:US
Practice Address - Phone:561-459-8078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9293488363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily