Individual
KAYLA WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
917 CEDAR COVE RD, WELLINGTON, FL 33414-6305
(561) 601-2998
Mailing address
917 CEDAR COVE RD, WELLINGTON, FL 33414-6305
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11037102
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/19/2024
Last updated
01/19/2025
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