Provider Demographics
NPI:1144033945
Name:SHIWBALAK, ANNALISA H
Entity type:Individual
Prefix:
First Name:ANNALISA
Middle Name:H
Last Name:SHIWBALAK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13968 WINEBERRY DR
Mailing Address - Street 2:
Mailing Address - City:DADE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33525-5960
Mailing Address - Country:US
Mailing Address - Phone:813-618-6198
Mailing Address - Fax:
Practice Address - Street 1:13968 WINEBERRY DR
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5960
Practice Address - Country:US
Practice Address - Phone:813-618-6198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9608541163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse