NICOLE WALLACE

LAKELAND, FL
NPI1508889254
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: FL  PA9103316)
Enumeration Date2006-07-25
Last Update Date2010-05-05
Business Address
Mrs. NICOLE WALLACE PA
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805-4543
Phone number: 863-687-1132
Mailing Address
Mrs. NICOLE WALLACE PA
5026 FAIRFAX DR
LAKELAND, FL 33813-2917
Phone number: 863-644-2455
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