Individual
GRACE CHRISTIANNE MANUELA WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
WHNP
Contact information
Practice address
1600 W COMMERCIAL BLVD, FORT LAUDERDALE, FL 33309-3006
(954) 318-1620
Mailing address
207 VARSITY CIR, ALTAMONTE SPRINGS, FL 32714-2835
(407) 496-7157
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
APRN11047255
FL
Other
Enumeration date
05/04/2026
Last updated
05/04/2026
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