Healthcare Provider Details

I. General information

NPI: 1235430034
Provider Name (Legal Business Name): WHITNEY HANNA BALMERT PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N THORNTON AVE
ORLANDO FL
32803-4003
US

IV. Provider business mailing address

1736 INDIANA AVE
WINTER PARK FL
32789-5447
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-8768
  • Fax: 407-894-6872
Mailing address:
  • Phone: 330-283-0376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA9105724
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: