Provider Demographics
NPI:1922058700
Name:BALDWIN, STEPHANIE C (DPM)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:C
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 E BEARSS AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-2451
Mailing Address - Country:US
Mailing Address - Phone:813-972-4300
Mailing Address - Fax:813-972-4180
Practice Address - Street 1:1706 E BEARSS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-2451
Practice Address - Country:US
Practice Address - Phone:813-972-4300
Practice Address - Fax:813-972-4180
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1557213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041413100Medicaid
FL0896490001Medicare NSC
FL041413100Medicaid
FL87861ZMedicare PIN