Healthcare Provider Details

I. General information

NPI: 1235579079
Provider Name (Legal Business Name): SHARLEEN VILLASOL BALLANCE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5016 W CACTUS RD
GLENDALE AZ
85304-2245
US

IV. Provider business mailing address

6101 BLUE LAGOON DR STE 200
MIAMI FL
33126-3168
US

V. Phone/Fax

Practice location:
  • Phone: 602-842-4983
  • Fax: 877-536-8327
Mailing address:
  • Phone: 305-500-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP5027
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP5027
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: