Individual
LATIERE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
14527 7TH ST, DADE CITY, FL 33523-3102
(352) 521-1474
Mailing address
5222 BLUE ROAN WAY, WESLEY CHAPEL, FL 33544-1829
(727) 510-5070
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
11023599
FL
Other
Enumeration date
01/30/2023
Last updated
05/11/2023
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