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

Jennifer Lea Wallace, PAC

Individual provider Medical Physician Assistant · NPI 1700864493

Jennifer Lea Wallace, PAC is a Medical Physician Assistant in Saint Petersburg, Florida. Licensed in Florida. Registered with an NPI since 2006.

Licensed in
FL
In the registry since
2006
Specialties on file
2
What do these letters mean?
PAC — Physician Assistant, Certified
A physician assistant holding current national certification; usually written PA-C.

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Practice location Address checks out

625 6th Ave S Ste 385
Saint Petersburg, FL 33701-4662
Phone: (727) 553-7100
Fax: (727) 553-7198
Show map & directions

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

Specialties & licences

Medical Physician Assistant (primary) Taxonomy 363AM0700X · Licence PA9105134 (FL)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence PA9105134 (FL)

Record details

NPI number1700864493
Entity typeIndividual (Type 1)
GenderFemale
Credentials PAC
Sole proprietorNo
NPI enumeratedJanuary 4, 2006
Last updated in NPPESOctober 8, 2015

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