Individual
MS. PATRICIA J WALLACE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP-BC
Contact information
Practice address
9471 BAYMEADOWS RD, STE 303, JACKSONVILLE, FL 32256-7936
(904) 332-7431
(904) 332-7408
Mailing address
4217 BAYMEADOWS RD, SUITE 3, JACKSONVILLE, FL 32217-4676
(904) 332-7431
(904) 332-7408
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
637272
FL
Other
Enumeration date
12/18/2006
Last updated
10/25/2017
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