| Provider / Organization | NPI | Date Certified |
|---|---|---|
| JENNIFER M WALLACE | 1972791747 | 2024-09-07 |
Jennifer M Wallace [F] graduated in 2007 and primarily specializes in Physician Assistant.
Jennifer M Wallace is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1972791747. Registration indicates Jennifer M Wallace is a provider of access to adult/geriatric primary care providers services with a specialization in Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant Access to Pediatric Primary Care Providers (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (Physician Assistant, ) (Physician Assistants & Advanced Practice Nursing Providers, Physician Assistant) (All Other Specialties & Provider Types, ) (Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers)
| PECOS ID | 5496844250 |
| Registration | PART-B:Y DME:Y HHA:Y PMD:Y |
| Entity Type | Individual |
| Provider Name | Jennifer M Wallace PA-C |
| Practice Office Address | 603 7TH ST S STE 540 ST PETERSBURG, FL US |
| Practice Office Telephone | 7275537550 |
| Practice Office Fax | 7275537547 |
| Mailing Address | 2995 DREW ST FL 2 CLEARWATER, FL 337593012 US |
| Business Telephone | 7273157496 |
| Direct Messaging Address [] | [email protected] | Health Information Exchange (HIE) BayCare Medical Group, Inc. |
| Code | Practice | License No State |
|---|---|---|
| 363A00000X PRIMARY | Access to Adult/Geriatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician AssistantAccess to Pediatric Primary Care Providers Physician Assistants & Advanced Practice Nursing Providers Physician Assistant Physician Assistant Physician Assistants & Advanced Practice Nursing Providers Physician Assistant All Other Specialties & Provider Types Physician Assistant Physician Assistants & Advanced Practice Nursing Providers | PA9104356
FL |