Individual
PEGGY LYNN WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
4600 N HABANA AVE, SUITE 15, TAMPA, FL 33614-7112
(813) 870-4460
Mailing address
110 W NORTH ST, TAMPA, FL 33604-6015
(813) 857-2679
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
9274861
FL
Other
Enumeration date
02/09/2011
Last updated
05/20/2011
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