Wallace, Jennifer Lea

Wallace, Jennifer Lea is an individual health care provider with primary practice located at 625 6Th Ave S Suite 385, Saint Petersburg FL 33701-4662. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Medical is her primary health care specialty. Wallace, Jennifer Lea can be contacted via phone (727) 553-7100.

Contact Information

Primary practice address
625 6Th Ave S Suite 385 Saint Petersburg FL 33701-4662
Phone: (727) 553-7100
Fax: (727) 553-7198
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9105134 Florida
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X PA9105134 Florida

Profile Details

NPI number 1700864493
LBN Legal business name Wallace, Jennifer Lea
Credentials PAC
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 4th, 2006
Last updated Oct 8th, 2015 - about 10 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.

Request for update

Popular Providers