LATOYA M. WALLACE (NPI# 1073764114) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073764114 |
| Entity Type | Individual |
| Full Name | LATOYA M. WALLACE |
| Credential | PA |
| Practice Address |
1010 N 12th Ave Ste 125 Pensacola FL 32501-3315 |
| Mailing Address |
1010 N 12th Ave Pensacola FL 32501-3370 |
| Practice Telephone | 8503618598 |
| Practice Fax Number | 8502034629 |
| Mailing Telephone | 4109087714 |
| Mailing Fax Number | 8502034629 |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2020-04-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9109974 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AM0700X |
Physician Assistant Specialization: Medical |
PA9109974 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| N | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
4254 | AZ | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| FL | BCBSFL | ZA98W | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1717 N E St, 208, Pensacola, FL 325016339 | 8504697771 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891901930 | Latoya Wallace | Case Manager/Care Coordinator | 2707 Browns Ln, Jonesboro, AR 72401-7213 | 2007-05-15 |
| Street Address |
1010 N 12TH AVE STE 125 |
| City | PENSACOLA |
| State | FL |
| Zip Code | 32501-3315 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992320881 | Access To Care, P.a. | Physician Assistant | 1010 N 12th Ave Ste 125, Pensacola, FL 32501-3315 | 2020-06-16 |
| 1881116374 | Redefine Your Story, LLC | Social Worker | 1010 N 12th Ave Ste 125, Pensacola, FL 32501-3315 | 2017-07-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669084976 | Steven Bollen | Pharmacist | 870 E Cervantes, Pensacola, FL 32501 | 2020-08-18 |
| 1013558733 | Erica Watts | Social Worker | 901 North I Street, Pensacola, FL 32501 | 2019-10-03 |
| 1972164598 | Yabin Chen | Student in an Organized Health Care Education/Training Program | Fairfield Pediatrics, 1295 W. Fairfield Drive, Pensacola, FL 32501 | 2019-06-25 |
| 1336700038 | Michael Enriquez | Student in an Organized Health Care Education/Training Program | Fairfield Pediatrics- Community Health Nw Fl, 1295 W Fairfield Drive, Pensacola, FL 32501 | 2019-06-24 |
| 1336631803 | Ana Andreea Curta | Student in an Organized Health Care Education/Training Program | Community Health Northwest Florida, 1295 W. Fairfield Drive, Pensacola, FL 32501 | 2018-05-31 |
| 1700374618 | Telecia Walker | Massage Therapist | 1720 W. Fairfield Dr., Ste 309, Pensacola, FL 32501 | 2018-04-26 |
| 1578085254 | Mary Holland Hegarty | Physical Therapist | 1000 W, Moreno St, Pensacola, FL 32501 | 2017-07-13 |
| 1184162455 | Wal-mart Stores East Lp | Durable Medical Equipment & Medical Supplies | 1525 E Nine Mile Road, Pensacola, FL 32501 | 2017-02-07 |
| 1215271564 | Pathways for Change, Inc | Social Worker | 2050 West Blount Street, Pensacola, FL 32501 | 2012-11-26 |
| 1962697342 | Martha M Green | Family Medicine | 1717 N E St Ste 222a, Pensacola, FL 32501 | 2007-09-10 |
| Find all providers in zip 32501 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518593326 | Shelby Jane Carson | Physician Assistant | 8333 N Davis Hwy Fl 3, Pensacola, FL 32514-6050 | 2020-03-13 |
| 1477194934 | Alyssa Brooke Mayer | Physician Assistant | 4501 N Davis Hwy Ste A, Pensacola, FL 32503-2724 | 2019-10-04 |
| 1720638448 | Frances Ponsuwan Bell | Physician Assistant | 5151 N 9th Ave # 200, Pensacola, FL 32504-8721 | 2019-09-14 |
| 1881242022 | Kendall Hoover | Physician Assistant | 190 E Intendencia St # A-28, Pensacola, FL 32502-5806 | 2019-08-30 |
| 1477047181 | Taylor Elaine Morrison | Physician Assistant | 4901 Marketplace Road, Pensacola, FL 32504-8986 | 2018-06-15 |
| 1245771591 | Tina Rayfield | Physician Assistant | 12480 Seratine Dr, Pensacola, FL 32506-9601 | 2017-03-19 |
| 1891166344 | Kevin Lacz | Physician Assistant | 100 S Baylen St, Suite A, Pensacola, FL 32502-5825 | 2015-10-09 |
| 1831448653 | Hillary H. Doussan | Physician Assistant | 8333 N. Davis Hwy, Pensacola, FL 32514-6050 | 2012-09-07 |
| 1891004560 | Lauren Andrea Treven | Physician Assistant | 3205 E Olive Rd, Apt 80, Pensacola, FL 32514-7239 | 2010-09-29 |
| 1285948703 | Sarah Grace Purdy | Physician Assistant | 5503 Admiral Doyle Rd, Pensacola, FL 32506-5353 | 2010-07-27 |
| Find all providers in PENSACOLA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.