Provider Demographics
NPI:1487636320
Name:BALFOUR, ANGELA MICHELLE (PAC)
Entity Type:Individual
Prefix:MISS
First Name:ANGELA
Middle Name:MICHELLE
Last Name:BALFOUR
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2276 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1437
Mailing Address - Country:US
Mailing Address - Phone:513-716-7751
Mailing Address - Fax:
Practice Address - Street 1:3001 N ROCKY POINT DR E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-5810
Practice Address - Country:US
Practice Address - Phone:813-289-9613
Practice Address - Fax:484-253-1790
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA-9104872363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000382162OtherANTHERM
OHQ56484Medicare UPIN
OH000000382162OtherANTHERM