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

La Tanya Wallace, FNP

Individual provider Registered Nurse · NPI 1841453487

La Tanya Wallace, FNP is a Nurse Practitioner in San Diego, California. Qualified in 2012, 14 years ago. Accepts Medicare assignment and offers telehealth. Licensed in California.

Years since qualifying
14
Licensed in
CA
In the registry since
2008
Specialties on file
5
What do these letters mean?
FNP — Family Nurse Practitioner
A nurse practitioner who treats patients of all ages, much like a family doctor.

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Practice location Address checks out

6921 Sperry Ct
San Diego, CA 92111-7030
Phone: (858) 717-0164
Fax: (888) 425-0508
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 22485 (CA)
Registered Nurse Taxonomy 163W00000X · Licence 680663 (CA)
Nurse Practitioner Taxonomy 363L00000X · Licence 22485 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 680663 (CA)
Family Nurse Practitioner Taxonomy 363LF0000X · Licence 22485 (CA)

Record details

NPI number1841453487
Entity typeIndividual (Type 1)
GenderFemale
Credentials FNP
Sole proprietorNo
NPI enumeratedJuly 3, 2008
Last updated in NPPESJanuary 28, 2024
Certification dateJanuary 28, 2024

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2012 (14 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

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