Balog, Amy L

Balog, Amy L is an individual health care provider with primary practice located at 661 Eyster Blvd Ste 2 , Rockledge FL 32955-8119. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Family. Physician Assistants & Advanced Practice Nursing Providers / Family is her primary health care specialty. Balog, Amy L can be contacted via phone (321) 806-1874.

Contact Information

Primary practice address
661 Eyster Blvd Ste 2 Rockledge FL 32955-8119
Phone: (321) 806-1874
Fax: (321) 806-1875
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 609756 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 337302 New York
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 11010379 Florida

Profile Details

NPI number 1720346869
LBN Legal business name Balog, Amy L
Credentials Nurse Practitioner (NP)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 26th, 2012
Last updated Oct 13th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1720346869 NPPES
New York MEDICAID 03457292
New York Other 120719000037

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