Provider Demographics
NPI:1962077735
Name:BALTAZAR, MYRIAM (ARNP)
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:BALTAZAR
Suffix:
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4238 NE 29TH PL
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34470-3366
Mailing Address - Country:US
Mailing Address - Phone:352-233-8044
Mailing Address - Fax:
Practice Address - Street 1:4238 NE 29TH PL # 2
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-3366
Practice Address - Country:US
Practice Address - Phone:352-233-8044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL05210327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily