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General NPI Number Information
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NPI Number | 1336445147
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Entity Type | Individual
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Provider Name | MARY BALLOU ARNP
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Gender | Female
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Dates
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Enumeration Date | 01/27/2011
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 1551 CLAY ST
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City | WINTER PARK
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State | FL
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Zip | 32789-5499
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Country | US
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Telephone | 407-644-5371
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Fax | 407-644-1417
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Provider Business Mailing Address
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Address Line | PO BOX 25317
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City | TAMPA
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State | FL
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Zip | 33622-5317
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Country | US
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Telephone | 813-286-0033
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Fax | 813-282-1806
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | ARNP2075302
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License Number State | FL
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