Patricia J Wallace, ARNP-BC

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

637272 Issued in FL

Practice address

9471 Baymeadows Rd
Ste 303
Jacksonville, FL 32256-7936

Phone

(904) 332-7431

Fax

(904) 332-7408

NPI assigned

Dec 18, 2006

Last updated

Oct 25, 2017By 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

Nurse Practitioner

State licenses

Practice roles

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.

• Hiten Kisnad MD PA

  dba Beaches Psychiatry

  • Psychiatry Physician
  • Jacksonville Beach, FL
  • NPI 1477500817
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1508889600000",
    "number": "1841353216",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 BAYMEADOWS RD",
            "address_2": "SUITE 3",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322174676",
            "telephone_number": "904-332-7431",
            "fax_number": "904-332-7408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9471 BAYMEADOWS RD",
            "address_2": "STE 303",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322567936",
            "telephone_number": "904-332-7431",
            "fax_number": "904-332-7408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "PATRICIA",
        "middle_name": "J",
        "name_prefix": "Ms.",
        "credential": "ARNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-18",
        "last_updated": "2017-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "637272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Lynn Wallace, RN
• Marquita Wallace, PHARMD, RPH
• Michael Wallace, MD
• Moira Petirs Wallace, M.D.
• Nicholas James Wallace, DMD
• Phillip Tyler Wallace, APRN
• Ricky Wallace
• Shanthalitta Seals Wallace, LMHC
• Taylor K Wallace, CNA
• Terrica Diane Wallace, PHARMD.

• Adult Health Nurse Practitioner in Jacksonville, FL
• Providers in Jacksonville, 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 Oct 25, 2017; 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.