Individual
JESSICA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDN, LDN
Contact information
Practice address
10000 BAY PINES BLVD, BAY PINES, FL 33744-8200
(727) 398-6661
Mailing address
4000 31ST AVE N, ST PETERSBURG, FL 33713-2218
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
7309
FL
Other
Enumeration date
01/30/2019
Last updated
01/30/2019
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