Basic Information
| Provider Information | |||||||||
| NPI: | 1720469026 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BALFE | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7593 W BOYNTON BEACH BLVD STE 220 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334376162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616497000 | ||||||||
| FaxNumber: | 8883162198 | ||||||||
| Practice Location | |||||||||
| Address1: | 5401 S CONGRESS AVE STE 105B | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334626636 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5617400545 | ||||||||
| FaxNumber: | 5617400262 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2015 | ||||||||
| LastUpdateDate: | 07/13/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA9108585 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 254016971 | 05 | FL | MEDICAID |