Provider Demographics
NPI:1306129697
Name:BALDWIN, JAMIE E (PA)
Entity type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:E
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MISS
Other - First Name:JAMIE
Other - Middle Name:E
Other - Last Name:CARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4036
Mailing Address - Fax:970-490-4378
Practice Address - Street 1:2400 S PEORIA ST
Practice Address - Street 2:#100
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5476
Practice Address - Country:US
Practice Address - Phone:303-306-4321
Practice Address - Fax:720-524-1551
Is Sole Proprietor?:No
Enumeration Date:2011-09-22
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPA-1125363AM0700X
CO3601363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39331873Medicaid
CO263960YMG5Medicare PIN