Healthcare Provider Details

I. General information

NPI: 1881482867
Provider Name (Legal Business Name): TIFFANI MICHELLE BALDWIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4428 S HEMLOCK AVE
SPRINGFIELD MO
65810-1086
US

IV. Provider business mailing address

4428 S HEMLOCK AVE
SPRINGFIELD MO
65810-1086
US

V. Phone/Fax

Practice location:
  • Phone: 417-860-5965
  • Fax:
Mailing address:
  • Phone: 417-860-5965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2026013866
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: