Healthcare Provider Details

I. General information

NPI: 1114770849
Provider Name (Legal Business Name): MARITZA BALZARINI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

IV. Provider business mailing address

13127 VAIL RIDGE DR
RIVERVIEW FL
33579-7196
US

V. Phone/Fax

Practice location:
  • Phone: 813-661-6199
  • Fax: 813-661-6334
Mailing address:
  • Phone: 813-661-6199
  • Fax: 813-661-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031654
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: