Healthcare Provider Details

I. General information

NPI: 1053927632
Provider Name (Legal Business Name): LEONOR BALART
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2020
Last Update Date: 08/27/2021
Certification Date: 08/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2137 W MLK BLVD
TAMPA FL
33607-6511
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-9384
  • Fax: 813-872-7637
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11009211
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: