PEGGY LYNN WALLACE


Address: 4600 N Habana Ave, Suite 15, Tampa, FL 33614-7112
Phone: 8138704460

PEGGY LYNN WALLACE (NPI# 1285930123) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1285930123
Entity Type Individual
Full Name PEGGY LYNN WALLACE
Credential ARNP
Practice Address 4600 N Habana Ave
Suite 15
Tampa
FL 33614-7112
Mailing Address 110 W North St
Tampa
FL 33604-6015
Practice Telephone 8138704460
Mailing Telephone 8138572679
Enumeration Date 2011-02-09
Last Update Date 2011-05-20
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LA2200X Nurse Practitioner
Specialization: Adult Health
9274861 FL Physician Assistants & Advanced Practice Nursing Providers

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Office Location

Street Address 4600 N HABANA AVE
SUITE 15
City TAMPA
State FL
Zip Code 33614-7112

Providers in the same location

NPI Name Taxonomy Address Enumeration
1578559753 Leopoldo Grauer Md Pa Internal Medicine 4600 N Habana Ave, Ste 29, Tampa, FL 33614-7166 2005-09-23
1053701359 Luis E. Kortright M.d. Orthopaedic Surgery 4600 N Habana Ave, Suite # 6, Tampa, FL 33614-7112 2015-01-26
1780922997 Ruben J Perez-ramos Internal Medicine 4600 N Habana Ave, # 27, Tampa, FL 33614-7112 2013-01-23
1922342906 Md and Wellness Center Inc Clinic/Center 4600 N Habana Ave, Suite 12, Tampa, FL 33614-7112 2012-11-15
1811275720 Ramon Hugo Sanchez, M.d., Pa Independent Medical Examiner 4600 N Habana Ave, Suite 32, Tampa, FL 33614-7112 2011-07-26
1619268026 Genesis Physicians Group LLC Internal Medicine 4600 N Habana Ave, #27, Tampa, FL 33614-7112 2011-04-20
1164728630 G. E. Vega, M. D., P. A. Specialist 4600 N Habana Ave, Suite 33, Tampa, FL 33614-7112 2011-02-01
1174828313 Dr Anthony A Fernandez Md Pa Clinic/Center 4600 N Habana Ave, Ste 16, Tampa, FL 33614-7112 2011-01-19
1114231347 Joseph G Sinkovics Md Pa Clinic/Center 4600 N Habana Ave, Suite 9, Tampa, FL 33614-7112 2010-07-29
1225342553 Robert C Henderson Md Pa Orthopaedic Surgery 4600 N Habana Ave, 30, Tampa, FL 33614-7112 2010-07-28
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
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1982128062 Jaime F Casellas Md Corp Internal Medicine 4600 N Habana Ave Suit #13, Tampa, FL 33614 2017-07-31
1891219119 Waveney Gittens-williams Alzheimer Center (Dementia Center) 3706 W. Idle Wild Cir #203, Tampa, FL 33614 2017-07-28
1750811857 Syerita Nicole Morris Counselor 6800 N Dale Marby Hwy, Ste 164, Tampa, FL 33614 2017-06-13
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Taxonomy Information

Taxonomy Code 363LA2200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Adult Health

Taxonomy Definition

Definition to come...

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1912407628 Jonathan D Pope Nurse Practitioner 2708 N 22nd St, Tampa, FL 33605-2760 2018-02-19
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Competitor

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City TAMPA
Zip Code 33614

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Dataset Information

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.

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