MRS. NICOLE WALLACE (NPI# 1508889254) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508889254 |
| Entity Type | Individual |
| Full Name | MRS. NICOLE WALLACE |
| Credential | PA |
| Practice Address |
1324 Lakeland Hills Blvd Lakeland FL 33805-4543 |
| Mailing Address |
5026 Fairfax Dr Lakeland FL 33813-2917 |
| Practice Telephone | 8636871132 |
| Practice Fax Number | 8636871439 |
| Mailing Telephone | 8636442455 |
| Mailing Fax Number | 7275073618 |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-05-05 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA9103316 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275821993 | Nicole M. Wallace | Social Worker | 177 Main St Ste 206, Huntington, NY 11743-6917 | 2011-07-15 |
| 1366735839 | Nicole Mani Wallace | Chiropractor | 219 Main St Ste A, Pineville, NC 28134-7528 | 2011-05-17 |
| 1821311606 | Nicole Broadway Wallace | Counselor | 207 Belo Dr, Killeen, TX 76542-5598 | 2010-03-08 |
| 1154820868 | Nicole Janeen Wallace | Counselor | 174 Mine Lake Ct Ste 200, Raleigh, NC 27615-6417 | 2018-02-08 |
| 1588964787 | Nicole Wallace | Physical Therapist | 3350 La Jolla Village Drive, San Diego, CA 92161 | 2010-10-22 |
| 1609089028 | Nicole Marie Wallace | Specialist | 913 First Colonial Rd Ste 204, Virginia Beach, VA 23454-3198 | 2007-05-08 |
| Street Address |
1324 LAKELAND HILLS BLVD |
| City | LAKELAND |
| State | FL |
| Zip Code | 33805-4543 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760489900 | James Francis Murray II | Obstetrics & Gynecology | 1324 Lakeland Hills Blvd, Pavilion, Lakeland, FL 33508 | 2005-07-01 |
| 1144821059 | Jennifer Mclaughlin | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-11-06 |
| 1861092595 | Hortense Marcia Watson | Registered Nurse | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-10-30 |
| 1073129953 | Lilia Yakubov | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-09-16 |
| 1093340374 | Rashika Battle | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-03-07 |
| 1871128363 | Maria Lana Barnes | Registered Nurse | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-03-05 |
| 1710519129 | Joshua Parker Thompson | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2020-02-04 |
| 1932741683 | Katie Elizabeth Deines | Registered Nurse | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2019-10-15 |
| 1700428968 | Jasmine Nazirbage | Nurse Practitioner | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2019-10-09 |
| 1578104824 | Kristopher Dillon Wilson | Physician Assistant | 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 | 2019-10-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477188704 | Ernie Tairon Lugo | Nursing Home Administrator | 5210 State Road N 33, Lot 8, Lakeland, FL 33805 | 2020-03-06 |
| 1912546631 | Francis Esperanzate | Physical Therapist | 5070 Menlo Parke Way, Lakeland, FL 33805 | 2019-12-27 |
| 1689232514 | Anointed Touch | Home Health | 617 S Robson Street, Lakeland, FL 33805 | 2019-06-05 |
| 1083160642 | Cherlande Pierre | Chiropractor | 1507 Lakeland Hills Blvd Ste 109, Lakeland, FL 33805 | 2016-09-01 |
| 1992251706 | Damaris Salmeron | Physical Therapy Assistant | 3127 Us Hwy 98 N, Lakeland, FL 33805 | 2016-08-31 |
| 1831589076 | Sarah Mcneill | Pharmacist | 3124 Lakeland Hills Blvd, Lakeland, FL 33805 | 2015-01-26 |
| 1750706479 | Alison M Busby | Counselor | Achievement Academy Inc, 716 E. Bella Vista St, Lakeland, FL 33805 | 2014-03-04 |
| 1174872907 | William Vargas, M.d. P. A. | Anesthesiology | 202 Parkview Place, Lakeland, FL 33805 | 2012-09-07 |
| 1184998056 | Eduardo Francisco Lopez Garcia | Internal Medicine | 135 E First Street, Lakeland, FL 33805 | 2012-02-24 |
| 1255625513 | Navdeep Singh Jassal | Physical Medicine & Rehabilitation | 1417 Lakeland Hills Blvd Ste 201, Lakeland, FL 33805 | 2011-06-04 |
| Find all providers in zip 33805 | ||||
| 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 |
|---|---|---|---|---|
| 1609483619 | Melodey Aguirre | Physician Assistant | 3810 S Florida Ave Ste 120, Lakeland, FL 33813-1129 | 2020-09-24 |
| 1093321580 | Alison Palmer | Physician Assistant | 409 Aberdeen Ct N, Lakeland, FL 33813-1602 | 2020-09-20 |
| 1205448792 | Aditi Patel | Physician Assistant | 2151 Southern Oaks Ln, Lakeland, FL 33813-3197 | 2020-08-18 |
| 1780151605 | Leah Marie Carroll | Physician Assistant | 5216 Scotland Pl, Lakeland, FL 33813-3063 | 2018-10-29 |
| 1205327046 | Deniz Nebi | Physician Assistant | 1417 Lakeland Hills Blvd Ste 104, Lakeland, FL 33805-3200 | 2018-05-29 |
| 1568962017 | Gabriela Victoria Gamero | Physician Assistant | 6500 N Socrum Loop Rd # 100, Lakeland, FL 33809-4179 | 2018-02-20 |
| 1861845356 | Bethany Buisson | Physician Assistant | 9160 Highway 64 Ste 105, Lakeland, TN 38002-3011 | 2016-07-19 |
| 1841691136 | Colleen Morrison | Physician Assistant | 1610 Clarendon Ave, Lakeland, FL 33803-2506 | 2014-09-06 |
| 1003176322 | Nathaly Antigua Suarez | Physician Assistant | 1157 Thomasville Cir, Lakeland, FL 33811-3400 | 2012-05-21 |
| 1205126190 | Megan Marie Wagner | Physician Assistant | 4700 Research Way, Lakeland, FL 33805-8531 | 2011-04-12 |
| Find all providers in LAKELAND | ||||
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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.