Provider Demographics
NPI:1861019390
Name:BALZANO, DINA MARIE (DNP)
Entity Type:Individual
Prefix:MS
First Name:DINA
Middle Name:MARIE
Last Name:BALZANO
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10599 N TATUM BLVD STE F151
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-1053
Mailing Address - Country:US
Mailing Address - Phone:480-991-9271
Mailing Address - Fax:
Practice Address - Street 1:10599 N TATUM BLVD STE F151
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-1053
Practice Address - Country:US
Practice Address - Phone:480-991-9271
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2022-11-11
Deactivation Date:2022-08-02
Deactivation Code:
Reactivation Date:2022-08-26
Provider Licenses
StateLicense IDTaxonomies
AZ243256207Q00000X
TXAP141593363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine