Phillip Tyler Wallace is a Jacksonville, Florida based nurse practitioner with 6 years of experience in . He completed his graduation in 2019. He accepts the Medicare-approved amount. Patients will not be billed for any more than the Medicare deductible and coinsurance. Active license number of Phillip Tyler Wallace is APRN11003275 in Florida. His current practice location is 1325 San Marco Blvd Ste 300, Jacksonville. Patients can reach him at 904-253-6910 or can fax him at 904-253-6964. Phillip Tyler Wallace is APRN and his NPI number (Unique professional ID assigned by NPPES) is 1821647447. Phillip Tyler Wallace has completed additional training beyond basic nursing education and provides primary health care services in accordance with state nurse practice laws or statutes. NPs are trained to assess patient needs, order and interpret diagnostic and laboratory tests, diagnose disease, formulate and prescribe medications and treatment plans.
Complete Profile:
Phillip Tyler Wallace speciality, credentials, practice address, contact phone number and fax are as below.
Patients can call on the below given phone number for appointment.
Name:
Phillip Tyler Wallace
Specialization:
Nurse Practitioner (NP)
Gender:
Male
Credentials:
APRN
Experience:
6+ years
Medical School Attended:
Other
Graduation Year:
2019
Accepts Medicare Assignment:
Yes
Practice Address:
1325 San Marco Blvd Ste 300, Jacksonville, Florida, 32207-8567
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
PAC ID:
2961734421
Enrollment ID:
I20191101001897
NPI Number:
1821647447
NPI Enumeration Date:
06 Sep, 2019
NPI Last Update On:
19 Sep, 2022
Medical Licenses:
NPs can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Phillip Tyler Wallace are as mentioned below.
License Number
Specialization
State
Status
APRN11003275
Florida
Primary
Hospital Affiliation:
NPs can be affiliated to many hospitals whom they worked with in the past or are presently working with. One NP can be affiliated to four to five hospitals at a time.
Hospital Name (CCN)
State
Hospital Type
(100088)
Jacksonville, FL
Acute Care Hospital
Group Practice:
Group practices are practice of medicine by a group of NPs who share their premises and other resources. Following list states all the group name
with which Phillip Tyler Wallace is associated with along with the number of members in that group.
Organization Name (Group PAC ID)
Members
Respiratory Critical Care And Sleep Medicine Association,inc (3971602970)
32
Other Medical Identifiers:
Other legacy medical identifiers associated with Phillip Tyler Wallace such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
Identifier
Type
State
Issuer
104378700
Medicaid
Florida
Business Mailing Address:
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
Address:
Phillip Tyler Wallace 1325 San Marco Blvd Ste 300, Jacksonville, Florida
Zip:
32207-8567
Phone Number:
904-253-6910
Fax Number:
904-253-6964
Patients can reach Phillip Tyler Wallace at 1325 San Marco Blvd Ste 300, Jacksonville, Florida or can call to book an appointment on 904-253-6910.
Comments/ Reviews:
Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on 13 January, 2025.