# MRS. DEBRA ANN WALLACE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** Yes

## Provider details

- **NPI number:** 1912149188
- **Gender:** F

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 372600000X | Adult Companion | 684206296 | FL | — |
| 3747A0650X | Attendant Care Provider | 684206296 | FL | — |
| 3747P1801X | Personal Care Attendant | 684206296 | FL | — |
| 376K00000X | Nurse's Aide | CNA 54979 | FL | Yes |

## Other

- **Enumeration date:** 04/02/2009
- **Last updated:** 04/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 14627300 | — | FL |
| 05 | — | 684206296 | — | FL |
| 01 | — | CNA54979 | CNA | FL |