Provider Demographics
NPI:1508891722
Name:BALKMAN, EMILIE D (MPH, RD)
Entity type:Individual
Prefix:MS
First Name:EMILIE
Middle Name:D
Last Name:BALKMAN
Suffix:
Gender:F
Credentials:MPH, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 SEMINOLE RD
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32233-4141
Mailing Address - Country:US
Mailing Address - Phone:904-304-5672
Mailing Address - Fax:
Practice Address - Street 1:178 SEMINOLE RD
Practice Address - Street 2:
Practice Address - City:ATLANTIC BEACH
Practice Address - State:FL
Practice Address - Zip Code:32233-4141
Practice Address - Country:US
Practice Address - Phone:904-304-5672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2025-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND4697133V00000X
FLAPRN9355475363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered