Healthcare Provider Details

I. General information

NPI: 1821760455
Provider Name (Legal Business Name): EVA BALLARD ROBERTS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/06/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8000 SR 64 E
BRADENTON FL
34212
US

IV. Provider business mailing address

8000 SR 64 E
BRADENTON FL
34212
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1404
  • Fax: 941-761-0712
Mailing address:
  • Phone: 941-792-1404
  • Fax: 941-761-0712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9115867
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: