Individual
BETHANY FAITH WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 SW ARCHER RD, FL 5, GAINESVILLE, FL 32610-3003
(352) 265-0055
Mailing address
7494 APPOMATTOX AVE, KEYSTONE HEIGHTS, FL 32656-8103
(904) 505-1016
Taxonomy
Speciality
Code
Description
License number
State
376K00000X
Nurse's Aide
Primary
439086
FL
Other
Enumeration date
11/18/2024
Last updated
11/18/2024
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