Provider Demographics
NPI:1134221997
Name:BALDWIN, DIANNE (ARNP)
Entity type:Individual
Prefix:
First Name:DIANNE
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 1:4161 TAMIAMI TRL
Mailing Address - Street 2:SUITE 701
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-9204
Mailing Address - Country:US
Mailing Address - Phone:941-629-5356
Mailing Address - Fax:941-629-4987
Practice Address - Street 1:4161 TAMIAMI TRL
Practice Address - Street 2:SUITE 701
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-9204
Practice Address - Country:US
Practice Address - Phone:941-629-5356
Practice Address - Fax:941-629-4987
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNP9174970363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
E5499ZMedicare ID - Type Unspecified
S60658Medicare UPIN