Provider Demographics
NPI:1881204329
Name:BALLWEBER, TEIGE JEANETTE (APRN)
Entity type:Individual
Prefix:
First Name:TEIGE
Middle Name:JEANETTE
Last Name:BALLWEBER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N MILLS AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5722
Mailing Address - Country:US
Mailing Address - Phone:407-841-7290
Mailing Address - Fax:407-636-7800
Practice Address - Street 1:414 N MILLS AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5722
Practice Address - Country:US
Practice Address - Phone:407-841-7290
Practice Address - Fax:407-636-7800
Is Sole Proprietor?:No
Enumeration Date:2020-08-07
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008521363LF0000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily