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MRS. NICOLE WALLACE PA
NPI 1508889254
Physician Assistant in Lakeland, FL

Active since July 25, 2006PECOS Enrolled
1324 LAKELAND HILLS BLVD, LAKELAND, FL 33805(863) 687-1132(863) 687-1439 Get Directions Write a Review

NPPES record last updated: May 5, 2010. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mrs. Nicole Wallace Pa NPPES

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

MRS. NICOLE WALLACE PA (NPI 1508889254) is an individual physician assistant in Lakeland, Florida, licensed in Florida (PA9103316) and active in the NPI registry since July 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1508889254
Entity TypeIndividualFemale
Primary Taxonomy363A00000X
Provider Legal NameMRS. NICOLE WALLACECredential: PA
Location Address1324 LAKELAND HILLS BLVDLakeland, FL 33805-4543
Mailing Address5026 Fairfax DrLakeland, FL 33813-2917 · (863) 644-2455 · Fax (727) 507-3618
Phone(863) 687-1132
Fax(863) 687-1439
Sole ProprietorNo
Enumeration DateJuly 25, 2006
Last NPPES UpdateMay 5, 2010
✔ NPI 1508889254 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician AssistantPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363A00000X
License✔ Licensed in FL · PA9103316
Definition
A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.
1324 LAKELAND HILLS BLVD, Lakeland, FL 33805
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mrs. Nicole Wallace Pa 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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 33805 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
$70.04 typical visit price
range $17.57 – $139.16
Typical copayment $17.51 (range $4.39 – $34.79)
Most-billed visit code 99213
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 20

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

CHRISTIAN ABREU-RAMIREZ MD
Internal Medicine (Pulmonary Disease)
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1100
JARED MCLAUGHLIN
Emergency Medicine
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1100
JEFF RIGBY DO
Student in an Organized Health Care Education/Training Program
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1100
ANDREA BEALE A.R.N.P.
Nurse Practitioner
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 284-5020
MR. TAMI LYNN HOWER ARNP
Nurse Practitioner (Family)
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1321
DR. ADALBERTO ALFONSO MD
Emergency Medicine
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1359
DR. BISHOY KOLTA M.D.
Psychiatry & Neurology (Psychiatry)
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1275
MICALEIGH NOLL PHARMD
Pharmacist
1324 LAKELAND HILLS BLVD
LAKELAND, FL 33805
Polk County (863) 687-1100

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 Nicole Wallace's NPI number?

The NPI number for Nicole Wallace is 1508889254. It was assigned to this individual provider in the NPPES registry on July 25, 2006.

Where is Nicole Wallace located?

Nicole Wallace practices at 1324 Lakeland Hills Blvd, Lakeland, FL 33805. The listed phone number is (863) 687-1132.

What is Nicole Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant with taxonomy code 363A00000X.

Is Nicole Wallace enrolled in Medicare?

Yes. Nicole Wallace is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Nicole Wallace was last updated on May 5, 2010. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.