Individual provider · Type 1 NPI

Jennifer M. Wallace, PA-C

Surgical Physician Assistant · St. Petersburg, FL

NPI number 1972791747 Active

Practice location

620 10th St N Ste 1D
St. Petersburg, FL 33705-1407

Call (727) 828-8400 Map

Fax (727) 333-6435

Mailing address

2995 Drew St Fl 2
Clearwater, FL 33759-3012

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400XPA9104356 (FL)

Surgical Physician Assistant: Definition to come...

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About NPI 1972791747

Jennifer M. Wallace, PA-C's National Provider Identifier is 1972791747, issued on Oct 5, 2007. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in St. Petersburg, FL. The record was last updated on Mar 14, 2025.