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JENNIFER LEA WALLACE PAC
NPI 1700864493
Physician Assistant - Medical in Saint Petersburg, FL

Active since January 04, 2006
625 6TH AVE S, SUITE 385, SAINT PETERSBURG, FL 33701(727) 553-7100(727) 553-7198 Get Directions Write a Review

NPPES record last updated: October 8, 2015. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jennifer Lea Wallace Pac NPPES

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

JENNIFER LEA WALLACE PAC (NPI 1700864493) is an individual medical provider in Saint Petersburg, Florida, licensed in Florida (PA9105134) and active in the NPI registry since January 2006.

NPPES Registry Identity

NPI1700864493
Entity TypeIndividualFemale
Primary Taxonomy363AM0700X
Provider Legal NameJENNIFER LEA WALLACECredential: PAC
Location Address625 6TH AVE S, SUITE 385Saint Petersburg, FL 33701-4662
Mailing Address625 6th Ave S, Suite 385Saint Petersburg, FL 33701-4662 · (727) 553-7100 · Fax (727) 553-7198
Phone(727) 553-7100
Fax(727) 553-7198
Sole ProprietorNo
Enumeration DateJanuary 4, 2006
Last NPPES UpdateOctober 8, 2015
✔ NPI 1700864493 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AM0700X
License✔ Licensed in FL · PA9105134
Also ListedPhysician Assistant · SurgicalTaxonomy 363AS0400X · License PA9105134 (FL)
625 6TH AVE S, Saint Petersburg, FL 33701
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Other Identifiers 2

Medicare UPINQ54100IL
Medicare PINK21619IL

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.

BRADLEY HARMON SIPE MD
Obstetrics & Gynecology (Maternal & Fetal Medicine)
625 6TH AVE S
ST PETERSBURG, FL 33701
Pinellas County (727) 767-7903
ADVANCED ENTS OF TAMPA BAY LLC
Otolaryngology (Pediatric Otolaryngology)
625 6TH AVE S, SUITE 385
SAINT PETERSBURG, FL 33701
Pinellas County (727) 553-7100
KRISTIN TEKOLA ARNP
Registered Nurse (Pediatrics)
625 6TH AVE S, 405
ST PETERSBURG, FL 33701
Pinellas County (727) 498-8994
WOMENS CARE FLORIDA LLP
Obstetrics & Gynecology
625 6TH AVE S, #350
ST PETERSBURG, FL 33701
Pinellas County (727) 456-0080
BURNES LYNN FEASTER III MD
Internal Medicine (Pulmonary Disease)
625 6TH AVE S, STE 475
ST PETERSBURG, FL 33701
Pinellas County (727) 895-7907
ALL CHILDREN'S PERINATOLOGY SPECIALISTS
Obstetrics & Gynecology (Maternal & Fetal Medicine)
625 6TH AVE S, SUITE 340
ST PETERSBURG, FL 33701
Pinellas County (727) 553-7903
MISS JOHN DANIEL HOCH
Student in an Organized Health Care Education/Training Program
625 6TH AVE S
ST PETERSBURG, FL 33701
Pinellas County (727) 568-6859
MS. CLAUDIA BOTERO PA
Physician Assistant (Medical)
625 6TH AVE S
ST PETERSBURG, FL 33701
Pinellas County (727) 553-7100

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 Jennifer Wallace's NPI number?

The NPI number for Jennifer Wallace is 1700864493. It was assigned to this individual provider in the NPPES registry on January 4, 2006.

Where is Jennifer Wallace located?

Jennifer Wallace practices at 625 6th Ave S Suite 385, Saint Petersburg, FL 33701. The listed phone number is (727) 553-7100.

What is Jennifer Wallace's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

When was this NPI record last updated?

The NPPES record for Jennifer Wallace was last updated on October 8, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 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.