Individual
TAYLOR K WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CNA
Contact information
Practice address
13525 BARTRAM PARK BLVD UNIT 1538, JACKSONVILLE, FL 32258-5271
(816) 832-6319
Mailing address
13525 BARTRAM PARK BLVD UNIT 1538, JACKSONVILLE, FL 32258-5271
(816) 832-6319
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
386143
FL
Other
Enumeration date
08/05/2020
Last updated
08/05/2020
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