Healthcare Provider Details

I. General information

NPI: 1639434657
Provider Name (Legal Business Name): THOMAS RICHARD BALDWIN CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2012
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 CLYDE MORRIS BLVD STE 500
PORT ORANGE FL
32129-2351
US

IV. Provider business mailing address

7 ELIZABETH LN
DAYTONA BEACH FL
32118-5201
US

V. Phone/Fax

Practice location:
  • Phone: 386-868-5034
  • Fax:
Mailing address:
  • Phone: 407-754-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP 9283066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: