Wallace, Latoya M.

Wallace, Latoya M. is an individual health care provider with primary practice located at 1010 N 12Th Ave Ste 125 , Pensacola FL 32501-3315. She recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Surgical, Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is her primary health care specialty. Wallace, Latoya M. can be contacted via phone (850) 361-8598.

Contact Information

Primary practice address
1010 N 12Th Ave Ste 125 Pensacola FL 32501-3315
Phone: (850) 361-8598
Fax: (850) 203-4629
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Surgical 363AS0400X 4254 Arizona
Physician Assistants & Advanced Practice Nursing Providers / Medical 363AM0700X PA9109974 Florida
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA9109974 Florida

Profile Details

NPI number 1073764114
LBN Legal business name Wallace, Latoya M.
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 7th, 2008
Last updated Apr 15th, 2020 - about 5 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 1073764114 NPPES
Florida Other ZA98W BCBSFL

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