Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | ARNP 9162317 | FL |
NPI | 1073568291 |
---|---|
Provider Name | Mrs. Carol Hase Baldwin |
First Address | Riviera Beach, FL 33410-7417 |
Second Address | Riviera Beach, FL 33410-7417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
ARNP 9162317 | LICENSE (01) | FL |