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Bernice E Wallace
Pediatric Nurse Practitioner in Plantation, Florida
NPI 1679887707

Bernice E Wallace is a Pediatric Nurse Practitioner based in Plantation, FL and is specialized in Pediatrics. Bernice E Wallace practices in Plantation, FL. The NPI Number for Bernice E Wallace is 1679887707 and holds a License No. ARNP1772012 (Florida).

The current practice location address for Bernice E Wallace is 4101 Nw 4Th St, Plantation, FL and can be reached out via phone at 954-791-5420 and via fax at 954-791-5950.

Location: 4101 Nw 4Th St, Plantation, FL, 33317-2850
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679887707
Provider Name
Bernice E Wallace
Credential
Provider Entity Type
Individual
Gender
Female
Address
4101 Nw 4Th St, Plantation, FL, 33317-2850
Phone Number
954-791-5420
Fax Number
954-791-5950
Provider Enumeration Date
07/30/2010
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
302604300 05 FL
institution
Provider Business Practice Location Address Details
Address
4101 Nw 4Th St
City
Plantation
State
Florida
Zip
33317-2850
Phone Number
954-791-5420
Fax Number
954-791-5950
person
Provider Business Mailing Address Details
Address
4101 Nw 4Th St
City
Plantation
State
Florida
Zip
33317-2850
Phone Number
954-791-5420
Fax Number
954-791-5950
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Pediatrics
Taxonomy
363LP0200X
License No.
ARNP1772012 (Florida)
Definition
Definition to come...
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