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

Ima Latoya Wallace

Individual provider Other Technician · NPI 1053063834

Ima Latoya Wallace is an Other Technician in Jacksonville, Florida. Practices as a sole proprietor. Registered with an NPI since 2022.

In the registry since
2022

Practice location Address checks out

9951 Atlantic Blvd Ste 300
Jacksonville, FL 32225-6574
Phone: (833) 434-5223
Fax: (888) 686-6271
Show map & directions

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

Specialties & licences

Other Technician (primary) Taxonomy 247200000X

Record details

NPI number1053063834
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedJanuary 22, 2022
Last updated in NPPESJune 17, 2022
Certification dateJune 17, 2022
Mailing address9951 Atlantic Blvd Ste 300, Jacksonville, FL 32225-6574

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