Provider Demographics
NPI:1780669663
Name:BALLARD, NANCY (ARNP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:BALLARD
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 1:603 S ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7320
Mailing Address - Country:US
Mailing Address - Phone:386-423-3303
Mailing Address - Fax:386-423-0042
Practice Address - Street 1:603 S ORANGE STREET
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7320
Practice Address - Country:US
Practice Address - Phone:386-423-0333
Practice Address - Fax:386-423-0042
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2993652363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP44756Medicare UPIN
FLE65337Medicare PIN
FL500026176Medicare PIN