Provider Demographics
NPI:1629443676
Name:BALLENILLA, EMMANUELLE (APN)
Entity type:Individual
Prefix:MRS
First Name:EMMANUELLE
Middle Name:
Last Name:BALLENILLA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7221 ALOMA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-7137
Mailing Address - Country:US
Mailing Address - Phone:407-537-9852
Mailing Address - Fax:866-725-4812
Practice Address - Street 1:7221 ALOMA AVE STE 200
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-7137
Practice Address - Country:US
Practice Address - Phone:407-657-2111
Practice Address - Fax:866-725-4812
Is Sole Proprietor?:No
Enumeration Date:2015-12-02
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9204317363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily