Wallace, Debra Ann

Wallace, Debra Ann is an sole proprietor health care provider with primary practice located at 5608 Kenny Dr , Tampa FL 33617-7711. She recently has 4 registered licenses in different health care specialties including Nursing Service Related Providers / Attendant Care Provider, Nursing Service Related Providers / Personal Care Attendant, Nursing Service Related Providers / Nurse's Aide, Nursing Service Related Providers / Adult Companion. Nursing Service Related Providers / Nurse's Aide is her primary health care specialty. Wallace, Debra Ann can be contacted via phone (813) 546-4884.

Contact Information

Primary practice address
5608 Kenny Dr Tampa FL 33617-7711
Phone: (813) 546-4884
Fax: (813) 983-1860
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Attendant Care Provider 3747A0650X 684206296 Florida
Nursing Service Related Providers / Personal Care Attendant 3747P1801X 684206296 Florida
Nursing Service Related Providers / Nurse's Aide 376K00000X CNA 54979 Florida
Nursing Service Related Providers / Adult Companion 372600000X 684206296 Florida

Profile Details

NPI number 1912149188
LBN Legal business name Wallace, Debra Ann
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Apr 2nd, 2009
Last updated Apr 2nd, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1912149188 NPPES
Florida MEDICAID 14627300
Florida Other CNA54979
Florida MEDICAID 684206296

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