MEDICARE: ANTOINETTE BALDWIN

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	106S00000X	Behavior Technician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982210720
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTOINETTE BALDWIN

Provider Business Mailing Address
First Line	:	2135 W STATE ROAD 434 STE 102
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-4983
Country	:	US
Telephone Number	:	407-789-2673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2135 W STATE ROAD 434 STE 102
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-4983
Country	:	US
Telephone Number	:	407-789-2673
Fax Number	:

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	12/05/2022

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Directions to “ ANTOINETTE BALDWIN ” Practice Location

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