Individual
EVELINE S. WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
2415 N ORANGE AVE, SUITE # 700, ORLANDO, FL 32804-5505
(407) 303-7171
(407) 303-7195
Mailing address
2415 N ORANGE AVE, SUITE # 700, ORLANDO, FL 32804-5505
(407) 303-7171
(407) 303-7195
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
1728202
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00360116
RAILROAD MEDICARE
FL
Enumeration date
07/26/2005
Last updated
11/11/2021
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