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NPI Code Detail

MEDICARE: MIRJAM BALL APRN

MEDICARE: MIRJAM BALL APRN
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
1363LF0000XFamily Nurse PractitionerARNP9304235FL

General Provider Information

NPI Number : 1518488790
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRJAM BALL APRN
Provider Business Mailing Address
First Line : 625 E TWIGGS ST STE 103
Second Line :
City : TAMPA
State : FL
Zip : 33602-3910
Country : US
Telephone Number : 813-228-7696
Fax Number : 813-228-0677
Provider Business Practice Location Address
First Line : 625 E TWIGGS ST STE 103
Second Line :
City : TAMPA
State : FL
Zip : 33602-3910
Country : US
Telephone Number : 813-228-7696
Fax Number : 813-228-0677
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2017
Last Update Date : 10/03/2024

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Directions to “ MIRJAM BALL APRN” Practice Location

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