Provider Demographics
NPI:1154888790
Name:BALDWIN, ZOMALAR TASHELL
Entity type:Individual
Prefix:
First Name:ZOMALAR
Middle Name:TASHELL
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2145 ROSE BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-4395
Mailing Address - Country:US
Mailing Address - Phone:863-326-8580
Mailing Address - Fax:
Practice Address - Street 1:2145 ROSE BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-4395
Practice Address - Country:US
Practice Address - Phone:863-326-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care