Individual
TRENEICE WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
7487 S STATE ROAD 121 # A, MACCLENNY, FL 32063-5451
(904) 330-2572
Mailing address
14511 MACADAMIA LN, JACKSONVILLE, FL 32218-1980
(954) 607-8406
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
9176588
FL
Other
Enumeration date
06/10/2025
Last updated
06/10/2025
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