Provider Demographics
NPI:1689313355
Name:BALLEW, ALEXANDRIA ADAMS (APRN)
Entity type:Individual
Prefix:
First Name:ALEXANDRIA
Middle Name:ADAMS
Last Name:BALLEW
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 1:11140 BOONER CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32526-4469
Mailing Address - Country:US
Mailing Address - Phone:251-363-5635
Mailing Address - Fax:
Practice Address - Street 1:3637 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-1075
Practice Address - Country:US
Practice Address - Phone:850-966-9099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11019643363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner