Provider Demographics
NPI:1144739293
Name:BALLESTAS, ANGELA MARIA (APRN)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIA
Last Name:BALLESTAS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:MARIA
Other - Last Name:DE MOYA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN-BC SA-C
Mailing Address - Street 1:136 SE 37TH TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-6240
Mailing Address - Country:US
Mailing Address - Phone:786-205-7567
Mailing Address - Fax:
Practice Address - Street 1:136 SE 37TH TER
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-6240
Practice Address - Country:US
Practice Address - Phone:786-205-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-20
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17-532246ZC0007X
FLAPRN-11023886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant