Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Wallace Family Practice PA

Organization Clinic/Center · NPI 1063548410

Wallace Family Practice PA is a Clinic/Center in Lehigh Acres, Florida. Licensed in Florida. Registered with an NPI since 2007.

Licensed in
FL
In the registry since
2007
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

3400 Lee Blvd Ste 108
Lehigh Acres, FL 33971-1309
Phone: (239) 369-2903
Fax: (239) 369-0500
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinic/Center (primary) Taxonomy 261Q00000X · Licence OS8622 (FL)

Record details

NPI number1063548410
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tasha Wallace — President · (239) 369-2903
NPI enumeratedFebruary 27, 2007
Last updated in NPPESDecember 29, 2010
Mailing address3400 Lee Blvd, Suite 108, Lehigh Acres, FL 33971-1309

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