Individual
ZANDRA WYNETTE WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
20316 NATURES CORNER DR, TAMPA, FL 33647-3580
(813) 575-8108
Mailing address
20316 NATURES CORNER DR, TAMPA, FL 33647-3580
(813) 575-8108
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
FL
Other
Enumeration date
01/26/2022
Last updated
01/26/2022
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