Provider Demographics
NPI:1013782747
Name:BALLESTAS, ADRIANA M (APRN)
Entity Type:Individual
Prefix:MRS
First Name:ADRIANA
Middle Name:M
Last Name:BALLESTAS
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 1:1268 SW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2915
Mailing Address - Country:US
Mailing Address - Phone:305-244-4430
Mailing Address - Fax:
Practice Address - Street 1:7300 SW 62ND PL FL 4
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4800
Practice Address - Country:US
Practice Address - Phone:305-662-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-22
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11029463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily