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General NPI Number Information
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NPI Number | 1972416337
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Entity Type | Individual
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Provider Name | ANNALIECE BALENSIEFEN CNM, WHNP-BC, APRN
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Gender | Female
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Dates
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Enumeration Date | 09/25/2026
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Last Update Date | 09/25/2026
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Provider Practice Location Address
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Address Line | 182 HOLDERNESS DR
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City | LONGWOOD
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State | FL
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Zip | 32779-5725
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Country | US
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Telephone | 815-878-9636
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Fax |
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Provider Business Mailing Address
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Address Line | 182 HOLDERNESS DR
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City | LONGWOOD
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State | FL
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Zip | 32779-5725
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Country | US
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Telephone |
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Fax |
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 104199230
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367A00000X
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Taxonomy Name | Advanced Practice Midwife
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License Number | 10795
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License Number State | FL
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