Mrs Nicole Wallace, PA in Lakeland, FL - Medicare Physician Assistant

Mrs Nicole Wallace, PA is a medicare enrolled "Physician Assistant" in Lakeland, Florida. Her current practice location is 1324 Lakeland Hills Blvd, Lakeland, Florida. You can reach out to her office (for appointments etc.) via phone at (863) 687-1132.

Mrs Nicole Wallace is licensed to practice in Florida (license number PA9103316) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1508889254.

Contact Information

	Mrs Nicole Wallace, PA
	1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543
	(863) 687-1132
	(863) 687-1439

Map and Direction

Provider's Profile

Full Name	Mrs Nicole Wallace
Gender	Female
Speciality	Physician Assistant
Location	1324 Lakeland Hills Blvd, Lakeland, Florida
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1508889254
Provider Enumeration Date: 07/25/2006
Last Update Date: 05/05/2010

Medicare PECOS Information:

PECOS PAC ID: 8022040112
Enrollment ID: I20050909000439

Medical Identifiers

Medical identifiers for Mrs Nicole Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1508889254	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
363A00000X	Physician Assistant	PA9103316 (Florida)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Nicole Wallace is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Mrs Nicole Wallace, PA 5026 Fairfax Dr, Lakeland, FL 33813-2917 Ph: (863) 644-2455	Mrs Nicole Wallace, PA 1324 Lakeland Hills Blvd, Lakeland, FL 33805-4543 Ph: (863) 687-1132

Reviews and Comments

Physician Assistant Nurses in Lakeland, FL

Nathaly Antigua Suarez, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1157 Thomasville Cir, Lakeland, FL 33811 Phone: 863-934-6230
Jennifer Alsina Gutierrez, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 2400 Kathleen Rd, Lakeland, FL 33810 Phone: 863-284-5000
Jasie Behrens, PA Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1755 N Florida Ave, Lakeland, FL 33805 Phone: 863-904-6201 Fax: 866-264-8519
Ms. Patricia Anne Keefe, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 3240 S Florida Ave Ste 101, Lakeland, FL 33803 Phone: 863-644-7337
Cory Adam Moogerfeld, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1324 Lakeland Hills Blvd, Lakeland, FL 33805 Phone: 863-687-1100
Veronica Trujillo, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 1417 Lakeland Hills Blvd Ste 201, Lakeland, FL 33805 Phone: 813-701-5804 Fax: 813-291-7615
Katie Reisman Lynch, PA-C Physician Assistant Medicare: Medicare Enrolled Practice Location: 1324 Lakeland Hills Blvd, Lakeland, FL 33805 Phone: 863-687-1100

Mrs Nicole Wallace, PA - Medicare Physician Assistant in Lakeland, FL