Lisa Lynn Wallace, RN

Primary specialty

Neonatal Intensive Care Registered NurseTaxonomy code 163WN0002X

License

RN089537 Issued in GA

Practice address

800 Prudential Dr
Jacksonville, FL 32207-8211

Phone

(904) 202-8000

NPI assigned

Nov 29, 2021

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Registered Nurse

State licenses

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

{
    "created_epoch": "1638144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638144000000",
    "number": "1396403135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "546 ROCKY CREEK RD",
            "city": "HAMPTON",
            "state": "GA",
            "postal_code": "302283071",
            "telephone_number": "678-414-7809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PRUDENTIAL DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322078211",
            "telephone_number": "904-202-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "LISA",
        "middle_name": "LYNN",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-29",
        "last_updated": "2021-11-29",
        "certification_date": "2021-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WN0002X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Neonatal Intensive Care",
            "state": "GA",
            "license": "RN089537",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joyce Wallace, CRNA, ARNP
• Kristen Paula Wallace, PA
• Leigh M Wallace, DDS
• Linda Wallace, MSW
• Lisa Wallace
• Marquita Wallace, PHARMD, RPH
• Michael Wallace, MD
• Moira Petirs Wallace, M.D.
• Nicholas James Wallace, DMD
• Patricia J Wallace, ARNP-BC

• Neonatal Intensive Care Registered Nurse in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Neonatal Intensive Care Registered Nurse in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.