MS. SUSAN ANN WALLACE (NPI# 1104000199) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104000199 |
| Entity Type | Individual |
| Full Name | MS. SUSAN ANN WALLACE |
| Other Name | MS. SUSAN ANN HAYMAN |
| Practice Address |
17501 Dale Mabry Hwy N Lutz FL 33548-4521 |
| Practice Telephone | 8139621000 |
| Mailing Telephone | 8139621000 |
| Enumeration Date | 2007-12-26 |
| Last Update Date | 2007-12-26 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
ARNP3262052 | FL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477910792 | Susan Anne Wallace | Licensed Practical Nurse | 44 Beechwood Dr, Manorville, NY 11949-2947 | 2016-01-16 |
| 1376842732 | Susan Elizabeth Wallace | Dietitian, Registered | 102 Carran Dr, Lakeside Park, KY 41017-2233 | 2011-03-23 |
| 1598904427 | Susan Leigh Wallace | Specialist | 103 Windwood Rd, North Syracuse, NY 13212-1956 | 2009-02-17 |
| 1366646457 | Susan Taylor Wallace | Speech-Language Pathologist | 3409 Connection Dr, Fayetteville, NC 28311-0151 | 2007-06-12 |
| 1952426025 | Susan Wallace | Acupuncturist | 1009 Solano Ave, # A, Albany, CA 94706-1617 | 2007-03-20 |
| 1447375662 | Susan D. Wallace | Counselor | 166 Pawtucket Avenue, Pawtucket, RI 02860-3811 | 2007-03-20 |
| 1639554769 | Susan Wallace | Physical Therapist | 35 Medical Center Pkwy, Augusta, ME 04330-8160 | 2015-07-30 |
| 1740537687 | Susan R Wallace | Nurse Practitioner | 100 Methodist Blvd, Hattiesburg, MS 39402-1295 | 2012-08-09 |
| 1710247812 | Susan Victoria Wallace | Marriage & Family Therapist | 9685 Hayes St, Riverside, CA 92503-3660 | 2012-05-22 |
| 1427203462 | Susan Marie Wallace | Occupational Therapist | 355 Oak Grove Rd, Spartanburg, SC 29301-2537 | 2008-11-18 |
| Street Address |
17501 DALE MABRY HWY N |
| City | LUTZ |
| State | FL |
| Zip Code | 33548-4521 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558576090 | Khavir Ahmed Sharieff | General Practice | 17501 Dale Mabry Hwy N, Lutz, FL 33548 | 2007-05-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205337821 | Chiros On 54 LLC | Chiropractor | 1003 N Dale Mabry Hwy, Lutz, FL 33548 | 2018-02-28 |
| 1295233666 | Issac M Arroyo | Behavior Technician | 18288 Us 41, Lutz, FL 33548 | 2018-01-31 |
| 1699293225 | Lettuce Lake Emergency Physicians LLC | Physician Assistant | 1430 Dale Mabry Highway, Lutz, FL 33548 | 2017-09-04 |
| 1780010512 | Yanina Abaunza-fiallos Md Pa | Pediatrics | 17541 N. Dale Mabry Hwy., Lutz, FL 33548 | 2013-09-25 |
| 1891138459 | Atlas Medical Services, Inc | Durable Medical Equipment & Medical Supplies | 3859 Van Dyke Rd, Suite 161, Lutz, FL 33548 | 2013-04-14 |
| 1407122492 | Tania Isabel Mendoza | Pathology | 19045 N Dale Mabry Hwy, Lutz, FL 33548 | 2012-03-24 |
| 1528362944 | Life Discovery Counseling Center | Counselor | 18371 Exciting Idlewild Blvd, Lutz, FL 33548 | 2010-12-28 |
| 1356643423 | Heidi Jane Pickering | Chiropractor | 19011 N Dale Mabry, Lutz, FL 33548 | 2010-11-23 |
| 1992015762 | Yolanda R. Harper | Social Worker | 1527 Dale Mabry Hwy Ste 103, Lutz, FL 33548 | 2010-10-14 |
| 1821231846 | Michael Lee Bishop | Psychologist | 18958 N Dale Mabry Hwy, Ste 102, Lutz, FL 33548 | 2009-04-07 |
| Find all providers in zip 33548 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174672562 | Anne Marie Purdy | Nurse Practitioner | 18204 Bittern Ave, Lutz, FL 33558-2733 | 2007-01-09 |
| 1619504354 | Myrtle Ridge Primary Care, P.a | Nurse Practitioner | 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008 | 2020-03-24 |
| 1376170225 | Myrtle Ridge Healthcare Center, LLC | Nurse Practitioner | 1539 Dale Mabry Hwy Ste 102, Lutz, FL 33548-3008 | 2020-03-23 |
| 1295055242 | Sheryl Diane Fagan | Nurse Practitioner | 4211 Van Dyke Rd, Suite 200, Lutz, FL 33558-8005 | 2010-06-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193292 | Paulette Vital-herne | Nurse Practitioner | 4449 Old Highway 41 S, Sun City, FL 33586-9700 | 2020-10-26 |
| 1144828104 | Shilpa Narahari Reddy | Nurse Practitioner | 19435 N Coquina Way, Weston, FL 33332-2417 | 2020-10-13 |
| 1023615440 | Bridget Mary Rossi | Nurse Practitioner | 1536 Alford Street, Unit 5, Jacksonville, FL 32207-3220 | 2020-10-08 |
| 1154928612 | Haili Harless | Nurse Practitioner | 3961 23rd Ave N, Saint Petersburg, FL 33713-4850 | 2020-10-07 |
| 1679170674 | Lorena Beatriz Canelon | Nurse Practitioner | 16151 Sw 147th Ln, Miami, FL 33196-6416 | 2020-10-04 |
| 1851998082 | Sanon Edmond | Nurse Practitioner | 5236 Arbor Glen Cir, Lake Worth, FL 33463-8066 | 2020-10-01 |
| 1710594114 | Sumelia Waddell | Nurse Practitioner | 462 Ne 210th Circle Ter Apt 204, Miami, FL 33179-5236 | 2020-09-29 |
| 1780291526 | Ilmary De Los Angeles Jimenez | Nurse Practitioner | 7909 Biltmore Blvd, Miramar, FL 33023-5829 | 2020-09-25 |
| 1972119535 | Dennis Carmelo Cadiz Serfino | Nurse Practitioner | 1960 Willesdon Dr E, Jacksonville, FL 32246-0694 | 2020-09-18 |
| 1760097745 | Amanee Orra | Nurse Practitioner | 3982 Bee Ridge Rd Ste H-a, Sarasota, FL 34233-1211 | 2020-09-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.