WALLACE JEROME DEVRIES

TAMPA, FL
NPI1295204329
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: FL  11000148)
Enumeration Date2018-11-19
Last Update Date2018-11-19
Business Address
WALLACE JEROME DEVRIES FNP-C
9009 CORPORATE LAKE DR
TAMPA, FL 33634-2367
Phone number: 763-361-8001
Mailing Address
WALLACE JEROME DEVRIES FNP-C
118 E COWPEN LAKE POINT RD
HAWTHORNE, FL 32640-5702
Phone number: 435-849-6896
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