MEDICARE: AMY L BALOG 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	163W00000X	Registered Nurse	609756	NY
2	363LF0000X	Family Nurse Practitioner	337302	NY
3	363LF0000X	Family Nurse Practitioner	11010379	FL

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	120719000037	OTHER	NY	FIDELIS CARE NY

General Provider Information

NPI Number	:	1720346869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY L BALOG NP

Provider Business Mailing Address
First Line	:	661 EYSTER BLVD STE 2
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8119
Country	:	US
Telephone Number	:	337-349-5824
Fax Number	:	321-806-1875

Provider Business Practice Location Address
First Line	:	661 EYSTER BLVD STE 2
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-8119
Country	:	US
Telephone Number	:	321-806-1874
Fax Number	:	321-806-1875

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

Provider Enumeration Date	:	04/26/2012
Last Update Date	:	10/13/2021

Similar Medicare Providers

1548076359 — BEHAVIORAL HEALTH CENTERS, LLC
Practice Location Address:

661 EYSTER BLVD
ROCKLEDGE, FL
32955-8119

Practice Phone: 321-399-7374
Practice Fax: 321-321-9550

1427701788 — SARA DANIELLE MOORE ALLEN APRN
Practice Location Address:

661 EYSTER BLVD
ROCKLEDGE, FL
32955-8119

Practice Phone: 321-637-2755
Practice Fax: 321-636-4157

1982496022 — APPLIED PSYCHOPHYSIOLOGY SERVICES, LLC
Practice Location Address:

661 EYSTER BLVD
ROCKLEDGE, FL
32955-8119

Practice Phone: 772-248-4800
Practice Fax:

1881586048 — DANIELLE FRANCES STEVENS FNP-BC
Practice Location Address:

661 EYSTER BLVD
ROCKLEDGE, FL
32955-8119

Practice Phone: 321-321-9884
Practice Fax:

1952740565 — EMILY J. GROVES CRNA
Practice Location Address:

110 LONGWOOD AVE
ROCKLEDGE, FL
32955-2828

Practice Phone: 321-637-2616
Practice Fax:

1508799560 — KRYSTA PAZOS
Practice Location Address:

107 LONGWOOD AVE
ROCKLEDGE, FL
32955-2827

Practice Phone: 321-338-2419
Practice Fax:

Directions to “ AMY L BALOG NP” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.