Individual
AMANDA DENISE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
214 MORRISON RD STE 104, BRANDON, FL 33511-4849
(813) 681-6474
(813) 654-8473
Mailing address
214 MORRISON RD, STE 104, BRANDON, FL 33511-4849
(813) 681-6474
(813) 654-8473
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
11013133
FL
Other
Enumeration date
07/06/2021
Last updated
06/30/2022
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