Individual provider · Type 1 NPI
Colleen Wallace
Adult Medicine Physician · Umatilla, FL
NPI number
1992394423
Active
Practice location
287 S Central Ave
Umatilla, FL 32784-8411
Mailing address
PO Box 2485
Umatilla, FL 32784-2485
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Adult Medicine Physician Primary | 207QA0505X | 11011114 (FL) |
Adult Medicine Physician: The NUCC recommends this code not be used. Choose a more appropriate code.
2 other providers at this address
About NPI 1992394423
Colleen Wallace's National Provider Identifier is 1992394423, issued on Jan 11, 2021. The primary taxonomy on file is Adult Medicine Physician (207QA0505X), and the practice location is in Umatilla, FL. The record was last updated on Jan 21, 2021.