Nicole Wallace in Lakeland - Physician Assistant
Nicole Wallace - NPI 1508889254
Nicole Wallace is a Physician Assistant in Lakeland, Florida. Nicole Wallace practices all healthcare services and medical treatments related to Physician Assistant. The NPI Number for Nicole Wallace is 1508889254. The last update date is 2010-05-05.
Nicole Wallace's current location address is 1324 Lakeland Hills Blvd, Lakeland, Florida. You can contact this provider via phone number 8636871132 and fax number 8636871439. The mailing address for Nicole Wallace is 1324 Lakeland Hills Blvd, Lakeland, Florida. To know further, please read the information below!
Provider Profile Detail
| Provider Name | Nicole Wallace |
|---|---|
| Address | 1324 Lakeland Hills Blvd, Lakeland, Florida |
| Phone Number | 8636871132 |
| Fax Number | 8636871439 |
| Sole Proprietor | N |
| Credentials | PA |
NPI Number Detail
| NPI Number | 1508889254 |
|---|---|
| Provider Enumeration Date | 2006-07-25 |
| Last Updated Date | 2010-05-05 |
Provider Mailing Address Detail
| Address | 1324 Lakeland Hills Blvd |
|---|---|
| City | Lakeland |
| State | Florida (FL) |
| Post Code | 338054543 |
| Phone Number | 8636871132 |
| Fax Number | 8636871439 |
Provider's Primary Taxonomy Detail
| Speciality | Physician Assistant |
|---|---|
| Taxonomy | 363A00000X |
| Licence No | PA9103316 |
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Definition: A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perfor |
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Can you provide the Nicole Wallace's physical address?
The Nicole Wallace is physically located at 1324 Lakeland Hills Blvd, in the city of Lakeland, FL, with the postal code 338054543.
What is the Nicole Wallace's area of specialization and corresponding taxonomy classification?
The Nicole Wallace's specialty field is Physician Assistant, and it falls under the taxonomy code 363A00000X, which categorizes healthcare providers based on their specialties.
What is Nicole Wallace's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Nicole Wallace is Physician Assistant, and the taxonomy code that categorizes this field of expertise is 363A00000X.
On what date did the Nicole Wallace receive its 1508889254 assignment from the Centers for Medicare & Medicaid Services?
The Nicole Wallace was assigned its 1508889254 by the Centers for Medicare & Medicaid Services on 2006-07-25.
As of what date were the Nicole Wallace's details last updated?
The information pertaining to the Nicole Wallace, including its address, specialty, and other details, was most recently updated on 2010-05-05.
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