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1972791747
JENNIFER M WALLACE
ST PETERSBURG, FL
NPI
1972791747
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363A00000X Physician Assistant
(Licence: FL PA9104356)
Enumeration Date
2007-10-05
Last Update Date
2024-09-07
Business Address
JENNIFER M WALLACE PA-C
603 7TH ST S STE 540
ST PETERSBURG, FL 33701-4719
Phone number: 727-553-7550
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Mailing Address
JENNIFER M WALLACE PA-C
2995 DREW ST FL 2
CLEARWATER, FL 33759-3012
Phone number: 727-315-7496
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