Provider Demographics
NPI:1518488790
Name:BALL, MIRJAM (APRN)
Entity type:Individual
Prefix:
First Name:MIRJAM
Middle Name:
Last Name:BALL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MIRJAM
Other - Middle Name:
Other - Last Name:ZUSKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:625 E TWIGGS ST STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3910
Mailing Address - Country:US
Mailing Address - Phone:813-228-7696
Mailing Address - Fax:813-228-0677
Practice Address - Street 1:625 E TWIGGS ST STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-3910
Practice Address - Country:US
Practice Address - Phone:813-228-7696
Practice Address - Fax:813-228-0677
Is Sole Proprietor?:No
Enumeration Date:2017-06-28
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9304235363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily