JOSEPH JELKS WALLACE

PUNTA GORDA, FL
NPI1891275095
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy363LF0000X Nurse Practitioner, Family
(Licence: FL  866612)
Enumeration Date2018-08-16
Last Update Date2018-08-16
Business Address
JOSEPH JELKS WALLACE
23361 FERNDALE AVE
PUNTA GORDA, FL 33980-4814
Phone number: 239-281-8121
Mailing Address
JOSEPH JELKS WALLACE
23361 FERNDALE AVE
PUNTA GORDA, FL 33980-4814
Phone number: 239-281-8121
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