Basic Information
| Provider Information | |||||||||
| NPI: | 1235430034 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BALMERT | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | HANNA | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1736 INDIANA AVE | ||||||||
| Address2: | |||||||||
| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327895447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3302830376 | ||||||||
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| Practice Location | |||||||||
| Address1: | 844 N THORNTON AVE | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328034003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078948768 | ||||||||
| FaxNumber: | 4078946872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2010 | ||||||||
| LastUpdateDate: | 11/10/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | PA9105724 | FL | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | PA9105724 | 01 | FL | STATE LICENSE | OTHER |