BERNICE E WALLACE


Address: 4101 Nw 4th St, Suite 200, Plantation, FL 33317-2850
Phone: 9547915420

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).

Provider Overview

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

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 363LP0200X Nurse Practitioner
Specialization: Pediatrics
ARNP1772012 FL Physician Assistants & Advanced Practice Nursing Providers

Other Provider Identifier

State Issuer Identifier Type Code
FL 302604300 05

Other Providers BERNICE WALLACE

NPI Name Taxonomy Address Enumeration
1073000212 Bernice Lyntricia Wallace Licensed Practical Nurse 1791 Alum Creek Dr, Columbus, OH 43207-1708 2018-04-13

Office Location

Street Address 4101 NW 4TH ST
SUITE 200
City PLANTATION
State FL
Zip Code 33317-2850

Providers in the same location

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
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Providers in the same zip code

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
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Taxonomy Information

Taxonomy Code 363LP0200X
Grouping Physician Assistants & Advanced Practice Nursing Providers
Classification Nurse Practitioner
Specialization Pediatrics

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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
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Competitor

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City PLANTATION
Zip Code 33317

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Dataset Information

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.

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