Bernice E Wallace

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

ARNP1772012 Issued in FL

Practice address

4101 NW 4TH St
Suite 200
Plantation, FL 33317-2850

Phone

(954) 791-5420

Fax

(954) 791-5950

NPI assigned

Jul 30, 2010

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1280448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329350400000",
    "number": "1679887707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4101 NW 4TH ST",
            "address_2": "SUITE 200",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333172850",
            "telephone_number": "954-791-5420",
            "fax_number": "954-791-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4101 NW 4TH ST",
            "address_2": "SUITE 200",
            "city": "PLANTATION",
            "state": "FL",
            "postal_code": "333172850",
            "telephone_number": "954-791-5420",
            "fax_number": "954-791-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "BERNICE",
        "middle_name": "E",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-30",
        "last_updated": "2012-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP1772012",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "302604300",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Walk Tall Counseling Center LLC
• Maria Walke, ARNP
• Diane Cecile Walker, APRN
• Michele P Walker
• Karlee Walklett, PHARM.D.
• Jonathan Wallace, DPT
• Rhonda Sheila Wallach, L.M.H.C.
• Walmart
• Lindsey Walsh, PHYSICIAN ASSISTANT
• Nancy Haake Walter, APRN

• Pediatric Nurse Practitioner in Plantation, FL
• Providers in Plantation, FL by specialty
• Pediatric Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.