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1104000199
SUSAN ANN WALLACE
LUTZ, FL
NPI
1104000199
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Former Name
SUSAN ANN HAYMAN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363LA2200X Nurse Practitioner, Adult Health
(Licence: FL ARNP3262052)
Enumeration Date
2007-12-26
Last Update Date
2007-12-26
Business Address
Ms. SUSAN ANN WALLACE
17501 DALE MABRY HWY N
LUTZ, FL 33548-4521
Phone number: 813-962-1000
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Mailing Address
Ms. SUSAN ANN WALLACE
17501 DALE MABRY HWY N
LUTZ, FL 33548-4521
Phone number: 813-962-1000
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