Provider Demographics
NPI:1114027760
Name:BALANDRA, VALERIE G (ARNP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:G
Last Name:BALANDRA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 321
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34284-0321
Mailing Address - Country:US
Mailing Address - Phone:941-480-0564
Mailing Address - Fax:941-480-0565
Practice Address - Street 1:3392 MAGIC OAK LN
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-1822
Practice Address - Country:US
Practice Address - Phone:941-371-7997
Practice Address - Fax:941-371-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1347962163WP0809X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP12399Medicare UPIN
FLE4468Medicare ID - Type Unspecified