Allison Marie Wallum, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA9106452 Issued in FL

Practice address

3345 Waterman Way
Tavares, FL 32778-5220

Phone

(352) 742-2050

Fax

(352) 343-0154

NPI assigned

Apr 12, 2012

Last updated

Nov 7, 2018By 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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1334188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541548800000",
    "number": "1639436926",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3345 WATERMAN WAY",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785220",
            "telephone_number": "352-742-2050",
            "fax_number": "352-343-0154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3345 WATERMAN WAY",
            "city": "TAVARES",
            "state": "FL",
            "postal_code": "327785220",
            "telephone_number": "352-742-2050",
            "fax_number": "352-343-0154"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLUM",
        "first_name": "ALLISON",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-12",
        "last_updated": "2018-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "FL",
            "license": "PA9106452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kurt B Wagner, MD
• Sarah E. Waldrop, R.N. ,CRNFA
• Walgreen Co (Walgreens #12105)
• Walgreen Co (Walgreens #04648)
• Bernice L Walker
• Walter R Earnest, DPM
• Patrick Joseph Ward, SS, LMFT,LMHC,SAP
• Waterman Anesthesiology Group PA
• Waterman SNF Operations LLC (Solaris Healthcare Waterman)
• Tamara C Watkins

• Medical Physician Assistant in Tavares, FL
• Providers in Tavares, FL by specialty
• Medical Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2018; 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.