Individual
DEBBIE A. WALLACE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2235 VENETIAN COURT, SUITE 1, NAPLES, FL 34109
(239) 596-9337
(239) 596-9466
Mailing address
2235 VENETIAN COURT, SUITE 1, NAPLES, FL 34109
(239) 596-9337
(239) 596-9466
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9102648
FL
363AS0400X
Surgical Physician Assistant
PA02505
TX
363AS0400X
Surgical Physician Assistant
PA9102648
FL
Other
Enumeration date
06/06/2006
Last updated
03/05/2014
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