Provider Demographics
NPI:1841519261
Name:BALDWIN, VERONICA ELIZABETH
Entity type:Individual
Prefix:MS
First Name:VERONICA
Middle Name:ELIZABETH
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:ELIZABETH
Other - Last Name:MATTHEWS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1955 US 1 S
Mailing Address - Street 2:STE 100, FAMILY PRACTICE 2
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-3708
Mailing Address - Country:US
Mailing Address - Phone:904-825-5055
Mailing Address - Fax:904-825-5076
Practice Address - Street 1:1955 US 1 S
Practice Address - Street 2:STE 100, FAMILY PRACTICE 2
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-3708
Practice Address - Country:US
Practice Address - Phone:904-825-5055
Practice Address - Fax:904-825-5076
Is Sole Proprietor?:No
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator