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WALLACE FAMILY PRACTICE PA
NPI 1063548410
Clinic/Center in Lehigh Acres, FL

Active since February 27, 2007CLIA 10D1060360 · Waiver
3400 LEE BLVD, SUITE 108, LEHIGH ACRES, FL 33971(239) 369-2903(239) 369-0500 Get Directions Write a Review

NPPES record last updated: December 29, 2010. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Wallace Family Practice Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

WALLACE FAMILY PRACTICE PA (NPI 1063548410) is a healthcare organization registered as a clinic/center in Lehigh Acres, Florida and active in the NPI registry since February 2007. The organization holds a CLIA Waiver certificate valid through July 8, 2028 and lists Tasha B. Wallace, President, as its authorized official.

NPPES Registry Identity

NPI1063548410
Entity TypeOrganization
Primary Taxonomy261Q00000X
Legal Business NameWALLACE FAMILY PRACTICE PA
Location Address3400 LEE BLVD, SUITE 108Lehigh Acres, FL 33971-1309
Mailing Address3400 Lee Blvd, Suite 108Lehigh Acres, FL 33971-1309 · (239) 369-2903 · Fax (239) 369-0500
Phone(239) 369-2903
Fax(239) 369-0500
Organization SubpartNo
Authorized OfficialTasha B. WallacePresident · (239) 369-2903
Enumeration DateFebruary 27, 2007
Last NPPES UpdateDecember 29, 2010
✔ NPI 1063548410 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/CenterAmbulatory Health Care Facilities
Taxonomy Code261Q00000X
License✔ Licensed in FL · OS8622
Definition
A facility or distinct part of one used for the diagnosis and treatment of outpatients. Clinic/Center is irregularly defined, sometimes being limited to organizations serving specialized treatment requirements or distinct patient/client groups (e.g., radiology, poor, and public health).
3400 LEE BLVD, Lehigh Acres, FL 33971
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Other Identifiers 3

Medicare PINU1026YFL
Medicare UPINH90975FL
Medicare UPINAB224FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include AvMed.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D1060360

Wallace Family Practice, PA · Fort Myers, FL
Active · expires Jul 8, 2028
CLIA Number10D1060360
Laboratory TypePhysician Office
Certificate Effective DateJuly 9, 2026
Certificate Expiration DateJuly 8, 2028
Laboratory DirectorTasha B. Wallace
Laboratory Phone(239) 369-2903
Laboratory LocationWallace Family Practice, PA14651 Palm Beach Blvd - #100, Fort Myers, FL 33905
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

LEHIGH HMA PHYSICIAN MANAGEMENT, LLC
Podiatrist
3400 LEE BLVD, SUITE 106
LEHIGH ACRES, FL 33971
Lee County (239) 368-2211
KATRINE ATTIA FARAG DMD
Dentist (General Practice)
3400 LEE BLVD, UNITS 101-104
LEHIGH ACRES, FL 33971
Lee County (239) 344-2385
DR. JOSHUA CRAIG MORROW D.M.D.
Dentist (General Practice)
3400 LEE BLVD, SUITES 103 & 104
LEHIGH ACRES, FL 33971
Lee County (239) 344-2385
JANVIE MANOJ BHARUCHA DMD
Student in an Organized Health Care Education/Training Program
3400 LEE BLVD
LEHIGH ACRES, FL 33971
Lee County (239) 278-3600
KAGAN, JUGAN & ASSOCIATES
Orthopaedic Surgery
3400 LEE BLVD, SUITE 105
LEHIGH ACRES, FL 33971
Lee County (239) 368-8271

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Wallace Family Practice PA's NPI number?

The NPI number for Wallace Family Practice PA is 1063548410. It was assigned to this organization in the NPPES registry on February 27, 2007.

Where is Wallace Family Practice PA located?

Wallace Family Practice PA is located at 3400 Lee Blvd Suite 108, Lehigh Acres, FL 33971. The listed phone number is (239) 369-2903.

What is Wallace Family Practice PA's specialty?

The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.

Does Wallace Family Practice PA hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D1060360) is associated with this NPI, valid through July 8, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Wallace Family Practice PA accept?

Health plans from AvMed list Wallace Family Practice PA as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Wallace Family Practice PA was last updated on December 29, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.