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

Jennifer M Wallace, PA-C

Individual provider Surgical Physician Assistant · NPI 1972791747

Jennifer M Wallace, PA-C is a Physician Assistant in St Petersburg, Florida. Qualified in 2007, 19 years ago. Practices with Baycare Medical Group, Inc, a 1,530-clinician group and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
19
Licensed in
FL
In the registry since
2007
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

See every abbreviation used in this directory →

Claim this listing Report a problem Suggest an edit

Practice location Address checks out

620 10th St N Ste 1D
St Petersburg, FL 33705-1407
Phone: (727) 828-8400
Fax: (727) 333-6435
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

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

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence PA9104356 (FL)

Record details

NPI number1972791747
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorYes
NPI enumeratedOctober 5, 2007
Last updated in NPPESMarch 14, 2025
Certification dateMarch 14, 2025

Medicare enrollment

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

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2007 (19 years in practice)
Group practice Baycare Medical Group, Inc. — 1530 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in St Petersburg