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

Latoya M. Wallace, PA

Individual provider Surgical Physician Assistant · NPI 1073764114

Latoya M. Wallace, PA is a Surgical Physician Assistant in Pensacola, Florida. Works from 2 locations. Licensed in Arizona and Florida.

Licensed in
AZ, FL
In the registry since
2008
Specialties on file
3
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1010 N 12th Ave Ste 125
Pensacola, FL 32501-3315
Phone: (850) 361-8598
Fax: (850) 203-4629
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1717 N E St, Pensacola, FL 32501-6339 — (850) 469-7771

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9109974 (FL)
Surgical Physician Assistant Taxonomy 363AS0400X · Licence 4254 (AZ)
Medical Physician Assistant Taxonomy 363AM0700X · Licence PA9109974 (FL)

Record details

NPI number1073764114
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedOctober 7, 2008
Last updated in NPPESApril 15, 2020
Certification dateApril 15, 2020

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