Individual
JOYCE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA, ARNP
Contact information
Practice address
2165 HERSCHEL ST, JACKSONVILLE, FL 32204-3819
(904) 387-4030
Mailing address
916 ALAMEDA LN, SAINT JOHNS, FL 32259-6903
(419) 512-3374
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9309567
FL
367500000X
Certified Registered Nurse Anesthetist
Primary
9309567
FL
Other
Enumeration date
11/24/2013
Last updated
01/20/2014
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