Individual provider · Type 1 NPI

Nicole Wallace, PA

Physician Assistant · Lakeland, FL

NPI number 1508889254 Active

Practice location

1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543

Call (863) 687-1132 Map

Fax (863) 687-1439

Mailing address

5026 Fairfax Dr
Lakeland, FL 33813-2917

Specialties and licenses

TaxonomyCodeLicense
Physician Assistant Primary 363A00000XPA9103316 (FL)

Physician Assistant: 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 perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, orde…

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About NPI 1508889254

Nicole Wallace, PA's National Provider Identifier is 1508889254, issued on Jul 25, 2006. The primary taxonomy on file is Physician Assistant (363A00000X), and the practice location is in Lakeland, FL. The record was last updated on May 5, 2010.