Provider Demographics
NPI:1578834289
Name:BALKOM, MICHELE COLENE (ARNP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:COLENE
Last Name:BALKOM
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:COLENE
Other - Last Name:BALKOM-HILL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:10700 WILLOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-8292
Mailing Address - Country:US
Mailing Address - Phone:850-516-5096
Mailing Address - Fax:
Practice Address - Street 1:10700 WILLOW LAKE DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-8292
Practice Address - Country:US
Practice Address - Phone:850-516-5096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-26
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9171333163W00000X
TX695151163W00000X
FLARNP9171333363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse