Amanda Denise Wallace, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

11013133 Issued in FL

Practice address

214 Morrison Rd Ste 104
Brandon, FL 33511-4849

Phone

(813) 681-6474

Fax

(813) 654-8473

NPI assigned

Jul 6, 2021

Last updated

Jun 30, 2022By 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 1

Addresses

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: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Jose R Prieto MD PA

  dba Bay Area Infectious Disease Associates

  • Infectious Disease Physician
  • Brandon, FL
  • NPI 1689708844
  Medicare reassignment NPD

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

{
    "created_epoch": "1625529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656547200000",
    "number": "1275104796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "214 MORRISON RD",
            "address_2": "STE 104",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114849",
            "telephone_number": "813-681-6474",
            "fax_number": "813-654-8473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "214 MORRISON RD STE 104",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335114849",
            "telephone_number": "813-681-6474",
            "fax_number": "813-654-8473"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2590 Healing Way Ste 310",
            "address_purpose": "LOCATION",
            "city": "Wesley Chapel",
            "state": "FL",
            "postal_code": "335435497",
            "country_code": "US",
            "telephone_number": "813-333-1186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "AMANDA",
        "middle_name": "DENISE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-06",
        "last_updated": "2022-06-30",
        "certification_date": "2022-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "11013133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Walker, D.M.D.
• Erica Walker
• Justice Marie-Monae Walker, RTC
• Majuanna Walker
• Melissa Walker
• Aster Wallace, RBT
• Johntavia Wallace
• Raychelle Sheryl Wallace
• Jared John Wallen, M.D.
• Rebecca Wallington

• Family Nurse Practitioner in Brandon, FL
• Providers in Brandon, FL by specialty
• Family Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2022; 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.