Tanya C Wall, DDS

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

DN15601 Issued in FL

Practice address

2255 Dunn Ave
BLDG. 700
Jacksonville, FL 32218

Phone

(904) 751-5126

Fax

(904) 751-5146

NPI assigned

Aug 21, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546905600000",
    "number": "1063528586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26948",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32226",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2255 DUNN AVE",
            "address_2": "BLDG. 700",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32218",
            "telephone_number": "904-751-5126",
            "fax_number": "904-751-5146"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "TANYA",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2019-01-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "FL",
            "license": "DN15601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADI HEALTHY KIDS",
            "identifier": "70640",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0758264000",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William Bradbury Walker, PA-C
• Megan Elizabeth Walkowski, DPT
• Annette Faulkner Wall, ARNP
• Dana Lee Wall, OTR
• Roberta Vesta Wall, ARNP
• Terri Northup Wall, PH.D.
• Timothy E Wall, A.T.
• Angel Wallace
• Ari Wallace
• Bradley A Wallace, MD

• Pediatric Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatric Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.