BERNICE E WALLACE (NPI# 1679887707) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1679887707 |
Entity Type | Individual |
Full Name | BERNICE E WALLACE |
Practice Address |
4101 Nw 4th St Suite 200 Plantation FL 33317-2850 |
Practice Telephone | 9547915420 |
Practice Fax Number | 9547915950 |
Mailing Telephone | 9547915420 |
Mailing Fax Number | 9547915950 |
Enumeration Date | 2010-07-30 |
Last Update Date | 2012-02-16 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363LP0200X |
Nurse Practitioner Specialization: Pediatrics |
ARNP1772012 | FL | Physician Assistants & Advanced Practice Nursing Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
FL | 302604300 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1073000212 | Bernice Lyntricia Wallace | Licensed Practical Nurse | 1791 Alum Creek Dr, Columbus, OH 43207-1708 | 2018-04-13 |
Street Address |
4101 NW 4TH ST SUITE 200 |
City | PLANTATION |
State | FL |
Zip Code | 33317-2850 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235124629 | Andrew S Ellowitz | Orthopaedic Surgery | 4101 Nw 4th St, Suite 305, Plantation, FL 33317-2850 | 2005-09-13 |
1386141414 | Jessica Saint Clair | Nurse Practitioner | 4101 Nw 4th St, Plantation, FL 33317-2850 | 2018-04-05 |
1043757537 | Alan Bruce Dautch, Pa | Chiropractor | 4101 Nw 4th St, #208, Plantation, FL 33317-2850 | 2017-01-23 |
1750779682 | Claudine Mckenzie | Nurse Practitioner | 4101 Nw 4th St, Suite 200, Plantation, FL 33317-2850 | 2014-12-30 |
1073941324 | Syretta Morris | Nurse Practitioner | 4101 Nw 4th St, Suite 306, Plantation, FL 33317-2850 | 2013-10-24 |
1154762771 | Injury Treatment Center of Coral Springs, Inc. | Non-Pharmacy Dispensing Site | 4101 Nw 4th St, #208, Plantation, FL 33317-2850 | 2013-07-11 |
1235472671 | Genestem | Clinic/Center | 4101 Nw 4th St, Suite 211, Plantation, FL 33317-2850 | 2013-04-04 |
1710226055 | Michelle Margaret Roachford | Nurse Practitioner | 4101 Nw 4th St, Suite 306, Plantation, FL 33317-2850 | 2013-02-06 |
1891046199 | Jacqueline E. Smith Md. Pa | Ophthalmology | 4101 Nw 4th St, Suite 409, Plantation, FL 33317-2850 | 2012-09-26 |
1861748717 | Vicky Jasmine Marsh | Family Medicine | 4101 Nw 4th St, Suite 211, Plantation, FL 33317-2850 | 2012-07-30 |
Find all providers in the same location |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1437704434 | Md Now Medical Centers Inc | Clinic/Center | 4640 W Commercial Blvd, Tamarac, FL 33317 | 2019-08-06 |
1902348675 | Atroypen Group, Inc | Case Management | 4330 W Broward Blvd Ste R, Plantation, FL 33317 | 2016-11-13 |
1417329665 | Marie Eronne Jean Charles | Nurse Practitioner | 6901 Cypress Road, Plantation, FL 33317 | 2015-10-28 |
1871977025 | Yanliceth Rodriguez | Clinic/Center | 4430 Sw 22nd Ct, Ft Lauderdale, FL 33317 | 2015-07-17 |
1710361472 | Melissa Coffman | Physician Assistant | 960 Sw 74th Avenue, Plantation, FL 33317 | 2015-07-13 |
1134511058 | Emad Ziaden | Physical Therapist | 747 S. State Rd 7, Plantation, FL 33317 | 2015-03-02 |
1760880710 | Michael Robert Tanguay | Orthotist | 450 North State Road 7, Plantation, FL 33317 | 2014-12-08 |
1821427675 | Mankame, Dipak M., D.d.s., P.a. | Dentist | 300 N.w. 70th Ave Suite 109, Plantation, FL 33317 | 2013-11-02 |
1679828826 | Kozy Kove Assisted Living Facility | Assisted Living Facility | 490 Nw 45 Terr, Plantation, FL 33317 | 2012-07-13 |
1205102845 | Aratha Franklin Dixon | Psychologist | 4121 Nw 5th # 207, Plantation, FL 33317 | 2012-03-28 |
Find all providers in zip 33317 |
Taxonomy Code | 363LP0200X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Nurse Practitioner |
Specialization | Pediatrics |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1548296379 | Ellen S Mass | Nurse Practitioner | 8430 W Broward Blvd, Childrens Medical Association, Plantation, FL 33324-2700 | 2006-06-23 |
1457346900 | Matilda Francisca Jarocki | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2005-09-12 |
1487107025 | Sasheena Buchanan | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2016-08-01 |
1750788311 | Susanne Aiyer | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2014-11-25 |
1104250216 | Donna Mcevoy | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2013-08-26 |
1568807998 | Melissa Marie Charlton | Nurse Practitioner | 300 Nw 70th Ave, Plantation, FL 33317 | 2013-04-29 |
1891052460 | Suzette Annmarie Gray-walker | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2012-04-19 |
1932408408 | Erica Margaret Mcmullen | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2011-03-22 |
1164749784 | Joseph Gerard Celona | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2010-04-21 |
1619034626 | Lois K Bielicki | Nurse Practitioner | 9611 W Broward Blvd, Plantation, FL 33324-2334 | 2007-01-02 |
Find all providers in PLANTATION |
City | PLANTATION |
Zip Code | 33317 |
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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.