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

Colleen Wallace

Individual provider Adult Medicine Physician · NPI 1992394423

Colleen Wallace is a Nurse Practitioner in Umatilla, Florida. Qualified in 2020, 6 years ago. Practices as a sole proprietor, accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
6
Licensed in
FL
In the registry since
2021

Practice location Address checks out

287 S Central Ave
Umatilla, FL 32784-8411
Phone: (352) 747-0747
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Adult Medicine Physician (primary) Taxonomy 207QA0505X · Licence 11011114 (FL)

Record details

NPI number1992394423
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 11, 2021
Last updated in NPPESJanuary 21, 2021
Certification dateJanuary 21, 2021
Mailing addressPo Box 2485, Umatilla, FL 32784-2485

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2020 (6 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services