Individual provider Active NPI

Tashoy M Wallace, APRN

  • Adult Health Nurse Practitioner
  • Orlando, FL
National Provider Identifier
1891301164
Registry record updated Jun 25, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
APRN11016381 Issued in FL
Practice address
89 W Copeland Dr FL 2
Orlando, FL 32806-2002
Phone
(321) 841-7550
Fax
(321) 841-8185
NPI assigned
Sep 21, 2020
Last updated
Jun 25, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 25, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Acute Care Nurse Practitioner 363LA2100X RN205003 GA
Adult Health Nurse Practitioner 363LA2200X APRN11016381 FL Primary

Addresses

Primary practice location

89 W Copeland Dr FL 2
Orlando, FL 32806-2002

Mailing address

1414 Kuhl Ave # MP38
Orlando, FL 32806-2008
Phone (321) 842-4713

Other practice location 1

121 Odyssey Turn
Conyers, GA 30012-3681
Phone (404) 384-8019

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20220908002546 FL Practitioner - Nurse Practitioner 4183008238 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Orlando Health Medical Group IncGroup PAC ID 9537059084, 2,171 clinicians

Practice addresses (Care Compare)

89 W Copeland Dr
Orlando, FL 32806-2002
Phone (321) 841-7550

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.91 of 100Reported as group
Quality
61.18
Promoting interoperability
100
Improvement activities
40
Cost
71.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN205003GAMDAcute Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Orlando Health, Inc. Current Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2022 Accepting new patients
Orlando Health Medical Group Inc CurrentSince Sep 1, 2022 Accepting new patients

Locations

1414 Kuhl Ave
#38
Orlando, FL 32806
Phone (407) 481-7179

32 W Gore St
Orlando, FL 32806
Phone (321) 841-3820

89 W Copeland Dr
Orlando, FL 32806
Phone (407) 237-6333

89 W Copeland Dr
Fl 2
Orlando, FL 32806
Phone (321) 841-3303

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Interoperability endpoints

  • Direct secure messaging: twallace342202@orlandohealth.medalliesdirect.net

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1750809600000",
    "number": "1891301164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1414 KUHL AVE # MP38",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062008",
            "telephone_number": "321-842-4713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "89 W COPELAND DR FL 2",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328062002",
            "telephone_number": "321-841-7550",
            "fax_number": "321-841-8185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "121 Odyssey Turn",
            "address_purpose": "LOCATION",
            "city": "Conyers",
            "state": "GA",
            "postal_code": "300123681",
            "country_code": "US",
            "telephone_number": "404-384-8019",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "TASHOY",
        "middle_name": "M",
        "credential": "APRN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-21",
        "last_updated": "2025-06-25",
        "certification_date": "2025-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2100X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Acute Care",
            "state": "GA",
            "license": "RN205003",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "FL",
            "license": "APRN11016381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

Verify at the official NPI Registry.