Latoya M. Wallace, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9109974 Issued in FL

Practice address

1010 N 12TH Ave Ste 125
Pensacola, FL 32501-3315

Phone

(850) 361-8598

Fax

(850) 203-4629

NPI assigned

Oct 7, 2008

Last updated

Apr 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Access to Care, P.a.

  • Medical Physician Assistant
  • Pensacola, FL
  • NPI 1992320881
  NPD Authorized official
• Pensacola Emergency Physicians, LLC

  • Emergency Medicine Physician
  • Gulf Breeze, FL
  • NPI 1427356393
  NPD (past)
• Southwest Center for Neurological Surgeons PC

  • Specialist
  • Mesa, AZ
  • NPI 1891901088
  NPD (past)

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1073764114",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 N 12TH AVE",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325013370",
            "telephone_number": "410-908-7714",
            "fax_number": "850-203-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 N 12TH AVE STE 125",
            "city": "PENSACOLA",
            "state": "FL",
            "postal_code": "325013315",
            "telephone_number": "850-361-8598",
            "fax_number": "850-203-4629"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1717 N E St",
            "address_2": "208",
            "address_purpose": "LOCATION",
            "city": "Pensacola",
            "state": "FL",
            "postal_code": "325016339",
            "country_code": "US",
            "telephone_number": "850-469-7771",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LATOYA",
        "middle_name": "M.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-07",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9109974",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9109974",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "AZ",
            "license": "4254",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSFL",
            "identifier": "ZA98W",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shacovia Walker
• Stephanie Ann Walker, APRN
• Will Pope Walker, M.D., PH.D.
• Deanthia Ricara-Gigi Wallace, APRN
• James P Wallace, PT
• Victoria Wallace, LCSW
• Wanda Dannette Wallace, DSW, LCSW
• Aaron C Wallender, DDS, MD
• Mary B Waller, CRNA
• Virginia Walls

• Physician Assistant in Pensacola, FL
• Providers in Pensacola, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2020; 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.