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Joseph Jelks Wallace
Family Nurse Practitioner in Punta Gorda, Florida
NPI 1891275095

Joseph Jelks Wallace is a Family Nurse Practitioner based in Punta Gorda, FL and is specialized in Family. Joseph Jelks Wallace practices in Punta Gorda, FL. The NPI Number for Joseph Jelks Wallace is 1891275095 and holds a License No. 866612 (Florida).

The current practice location address for Joseph Jelks Wallace is 23361 Ferndale Ave, Punta Gorda, FL and can be reached out via phone at 239-281-8121.

Location: 23361 Ferndale Ave, Punta Gorda, FL, 33980-4814
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1891275095
Provider Name
Joseph Jelks Wallace
Credential
Provider Entity Type
Individual
Gender
Male
Address
23361 Ferndale Ave, Punta Gorda, FL, 33980-4814
Phone Number
239-281-8121
Fax Number
Provider Enumeration Date
08/16/2018
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
23361 Ferndale Ave
City
Punta Gorda
State
Florida
Zip
33980-4814
Phone Number
239-281-8121
Fax Number
person
Provider Business Mailing Address Details
Address
23361 Ferndale Ave
City
Punta Gorda
State
Florida
Zip
33980-4814
Phone Number
239-281-8121
Fax Number
person
Provider's Taxonomy Details 1
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
363LF0000X
License No.
866612 (Florida)
Definition
Definition to come...
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