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

Lisa Lynn Wallace, RN

Individual provider Neonatal Intensive Care Registered Nurse · NPI 1396403135

Lisa Lynn Wallace, RN is a Neonatal Intensive Care Registered Nurse in Jacksonville, Florida. Licensed in Georgia. Registered with an NPI since 2021.

Licensed in
GA
In the registry since
2021
What do these letters mean?
RN — Registered Nurse
A licensed nurse who completed a nursing degree and passed the NCLEX-RN examination.

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Practice location Address checks out

800 Prudential Dr
Jacksonville, FL 32207-8211
Phone: (904) 202-8000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Neonatal Intensive Care Registered Nurse (primary) Taxonomy 163WN0002X · Licence RN089537 (GA)

Record details

NPI number1396403135
Entity typeIndividual (Type 1)
GenderFemale
Credentials RN
Sole proprietorNo
NPI enumeratedNovember 29, 2021
Last updated in NPPESNovember 29, 2021
Certification dateNovember 29, 2021
Mailing address546 Rocky Creek Rd, Hampton, GA 30228-3071

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