Provider Demographics
NPI:1922584929
Name:BALSTER, MIRANDA YVONNE (APRN)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:YVONNE
Last Name:BALSTER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HEALING WAY STE 308
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5492
Mailing Address - Country:US
Mailing Address - Phone:813-929-5226
Mailing Address - Fax:813-929-5332
Practice Address - Street 1:2700 HEALING WAY STE 308
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5492
Practice Address - Country:US
Practice Address - Phone:813-929-5226
Practice Address - Fax:813-929-5332
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9358115363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care