Organization
WALLACE HEALTH, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. COLLEEN WALLACE NP-C (OWNER)
(352) 747-0747
Entity
Organization
Contact information
Practice address
287 S CENTRAL AVE, UMATILLA, FL 32784-8411
(352) 747-0747
Mailing address
PO BOX 2485, UMATILLA, FL 32784-2485
(352) 551-9404
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
—
—
Other
Enumeration date
01/27/2021
Last updated
01/27/2021
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