MEDICARE: KIMBERLY ANN BALLERINO APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	11002068	FL

General Provider Information

NPI Number	:	1689207680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY ANN BALLERINO APRN

Provider Business Mailing Address
First Line	:	5023 ROCK ROSE LOOP
Second Line	:
City	:	SANFORD
State	:	FL
Zip	:	32771-9203
Country	:	US
Telephone Number	:	321-277-2943
Fax Number	:

Provider Business Practice Location Address
First Line	:	8956 TURKEY LAKE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32819-7327
Country	:	US
Telephone Number	:	407-774-3325
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/18/2020
Last Update Date	:	02/18/2020

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