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

Dr. Tasha B Wallace, DO

Individual provider Family Medicine Physician · NPI 1396736997

Dr. Tasha B Wallace, DO is a Family Practice in Fort Myers, Florida. Graduated from Rowan University School of Osteopathic Medicine in 2000, 26 years ago. Accepts Medicare assignment and offers telehealth. Licensed in Florida.

Years since qualifying
26
Trained at
Rowan University School of Osteopathic Medicine
Licensed in
FL
In the registry since
2005
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

14651 Palm Beach Blvd Ste 100
Fort Myers, FL 33905-2331
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

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence OS8622 (FL)

Record details

NPI number1396736997
Entity typeIndividual (Type 1)
GenderFemale
Credentials DO
Sole proprietorNo
NPI enumeratedNovember 2, 2005
Last updated in NPPESAugust 27, 2024
Certification dateAugust 27, 2024
Mailing address14651 Palm Beach Blvd Ste 100, Fort Myers, FL 33905-2331

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolROWAN UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE
Graduated 2000 (26 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services
Practice locations2 on file with Medicare

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