Peggy Lynn Wallace, ARNP

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

9274861 Issued in FL

Practice address

4600 N Habana Ave
Suite 15
Tampa, FL 33614-7112

Phone

(813) 870-4460

NPI assigned

Feb 9, 2011

Last updated

May 20, 2011By 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

Specialty

Nurse Practitioner

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St. Joseph's Hospital, Inc.Group PAC ID 1658274287, shared by 5 NPIs, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Josephs Hospital Hospital, Tampa, FL, CCN 100075

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: peggy.wallaceaprn@direct.mybaycare.org

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.

• St. Joseph's Hospital, Inc.

  • Primary Care Clinic/Center
  • St Petersburg, FL
  • NPI 1710036868
  Medicare reassignment NPD
• St. Joseph's Hospital, Inc.

  • Primary Care Clinic/Center
  • Tampa, FL
  • NPI 1992854038
  Medicare reassignment NPD
• St Joseph's Hospital Inc

  dba Chronic Complex Clinic

  • Family Medicine Physician
  • Tampa, FL
  • NPI 1740901578
  NPD
• St. Joseph's Hospital, Inc.

  dba St. Joseph's Hospital

  • Clinical Medical Laboratory
  • Tampa, FL
  • NPI 1316531999
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St. Joseph's Hospital, Inc.

  dba St. Joseph's Women's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1346519816
  Care Compare affiliation
• St. Joseph's Hospital, Inc.

  dba St. Joseph's Hospital

  • General Acute Care Hospital
  • Tampa, FL
  • NPI 1881632818
  Care Compare affiliation

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

{
    "created_epoch": "1297209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1305849600000",
    "number": "1285930123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 W NORTH ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336046015",
            "telephone_number": "813-857-2679"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 N HABANA AVE",
            "address_2": "SUITE 15",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336147112",
            "telephone_number": "813-870-4460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PEGGY",
        "middle_name": "LYNN",
        "credential": "ARNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-09",
        "last_updated": "2011-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "9274861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jim Wall
• Madison Wall
• Anna Wallace
• Davina Wallace, M.S.,CCC-SLP
• Debra Ann Wallace
• Sergio Wallace
• Skye Wallace, M.S. CCC-SLP
• Tiaja Wallace
• Yelda N Wallace
• Zandra Wynette Wallace

• Adult Health Nurse Practitioner in Tampa, FL
• Providers in Tampa, FL by specialty
• Adult Health Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2011; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.