MEDICARE: STACY MARIE BALDWIN FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024168971	VA
2	363LF0000X	Family Nurse Practitioner	NPF95033207	CA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NPF95033207	CA
4	363LF0000X	Family Nurse Practitioner	95000726	CA

General Provider Information

NPI Number	:	1114236395
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STACY MARIE BALDWIN FNP-BC

Provider Business Mailing Address
First Line	:	150 VALPREDA RD
Second Line	:
City	:	SAN MARCOS
State	:	CA
Zip	:	92069-2973
Country	:	US
Telephone Number	:	760-736-6780
Fax Number	:

Provider Business Practice Location Address
First Line	:	3998 VISTA WAY STE 204
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-4515
Country	:	US
Telephone Number	:	760-736-6767
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	05/12/2025

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