Wallace, Jennifer M

Wallace, Jennifer M is an sole proprietor health care provider with primary practice located at 603 7Th St S Ste 540, St Petersburg FL 33701-4719. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Wallace, Jennifer M can be contacted via phone (727) 553-7550.

Contact Information

Primary practice address
603 7Th St S Ste 540 St Petersburg FL 33701-4719
Phone: (727) 553-7550
Fax: (727) 553-7547
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9104356 Florida

Profile Details

NPI number 1972791747
LBN Legal business name Wallace, Jennifer M
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Oct 5th, 2007
Last updated Oct 5th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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