Provider Demographics
NPI:1154082246
Name:BALLESTER, ELIZABETH EMILY (APRN)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:EMILY
Last Name:BALLESTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4584 BREAKWATER BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34607-2473
Mailing Address - Country:US
Mailing Address - Phone:352-398-7708
Mailing Address - Fax:
Practice Address - Street 1:8172 CHAUCER DR
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2204
Practice Address - Country:US
Practice Address - Phone:352-653-1101
Practice Address - Fax:855-919-6122
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-01
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11017048363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11477990Medicaid