Individual
MARY BALLOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
1551 CLAY ST, WINTER PARK, FL 32789-5499
(407) 644-5371
(407) 644-1417
Mailing address
PO BOX 25317, TAMPA, FL 33622-5317
(813) 286-0033
(813) 282-1806
Taxonomy
Speciality
Code
Description
License number
State
363LX0001X
Obstetrics & Gynecology Nurse Practitioner
Primary
ARNP2075302
FL
Other
Enumeration date
01/27/2011
Last updated
02/22/2012
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