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Individual
TASHOY M WALLACE
Active
Individual
TASHOY M WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
RN205003
GA
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN11016381
FL
Other
Enumeration date
09/21/2020
Last updated
06/25/2025
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