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Individual
MRS. DEBRA ANN WALLACE
Active
Individual
MRS. DEBRA ANN WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
684206296
FL
3747A0650X
Attendant Care Provider
684206296
FL
3747P1801X
Personal Care Attendant
684206296
FL
376K00000X
Nurse's Aide
Primary
CNA 54979
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14627300
—
FL
05
—
684206296
—
FL
01
—
CNA54979
CNA
FL
Enumeration date
04/02/2009
Last updated
04/02/2009
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