MEDICARE: JACQUITA NICOLE BALDWIN NP

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	RN204398	GA

General Provider Information

NPI Number	:	1861034415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUITA NICOLE BALDWIN NP

Provider Business Mailing Address
First Line	:	106 MORAN DR
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-5106
Country	:	US
Telephone Number	:	478-988-1282
Fax Number	:	478-988-3120

Provider Business Practice Location Address
First Line	:	106 MORAN DR
Second Line	:
City	:	BONAIRE
State	:	GA
Zip	:	31005-5106
Country	:	US
Telephone Number	:	478-988-1282
Fax Number	:	478-988-3120

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

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	09/18/2023

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