AMANDA DENISE WALLACE NP
NPI 1275104796
Nurse Practitioner - Family in Brandon, FL

Q: What is Amanda Wallace's NPI number?

The NPI number for Amanda Wallace is 1275104796. It was assigned to this individual provider in the NPPES registry on July 6, 2021.

Q: What is Amanda Wallace's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Q: When was this NPI record last updated?

The NPPES record for Amanda Wallace was last updated on June 30, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.

Active since July 06, 2021PECOS Enrolled

214 MORRISON RD STE 104, BRANDON, FL 33511(813) 681-6474(813) 654-8473 Get Directions Write a Review

NPPES record last updated: June 30, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: May 4, 2022, Jul 6, 2021 (2 updates tracked since 2021).

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About Amanda Denise Wallace Np NPPES

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

AMANDA DENISE WALLACE NP (NPI 1275104796) is an individual family provider in Brandon, Florida, licensed in Florida (11013133) and active in the NPI registry since July 2021. She is enrolled in Medicare PECOS and maintains a secondary practice location in Wesley Chapel.

NPPES Registry Identity

NPI1275104796

Entity TypeIndividualFemale

Primary Taxonomy363LF0000X

Provider Legal NameAMANDA DENISE WALLACECredential: NP

Location Address214 MORRISON RD STE 104Brandon, FL 33511-4849

Mailing Address214 Morrison Rd, Ste 104Brandon, FL 33511-4849 · (813) 681-6474 · Fax (813) 654-8473

Phone(813) 681-6474

Fax(813) 654-8473

Sole ProprietorNo

Enumeration DateJuly 6, 2021

Last NPPES UpdateJune 30, 20222 updates tracked since enumeration

NPPES CertifiedJune 30, 2022

✔ NPI 1275104796 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LF0000X

License✔ Licensed in FL · 11013133

214 MORRISON RD STE 104, Brandon, FL 33511

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Secondary Practice Location 1

Location 12590 Healing Way Ste 310Wesley Chapel, FL 33543-5497 · Phone (813) 333-1186

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Amanda Denise Wallace Np is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Amanda Wallace reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Jose R Prieto MD PA

Same address

Infectious Disease

214 MORRISON RD STE 104
Brandon, FL 33511

Reassigned Medicare billing, Florida enrollment
14 clinicians in this Medicare group

NPI 1689708844 (813) 681-6474

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33511 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$87.62 typical visit price

range $56.00 – $171.84

Typical copayment $21.90 (range $14.00 – $42.96)

Most-billed visit code 99203

Established Patient

$99.16 typical visit price

range $17.57 – $139.16

Typical copayment $24.79 (range $4.39 – $34.79)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 7

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

JOSE RAMON PRIETO M.D.

Internal Medicine (Infectious Disease)

214 MORRISON RD STE 104, BRANDON
BRANDON, FL 33511

Hillsborough County (813) 681-6474

ASHTON DAWNA MCGRIFF

Nurse Practitioner (Family)