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

Mrs. Nicole Wallace, PA

Individual provider Physician Assistant · NPI 1508889254

Mrs. Nicole Wallace, PA is a Physician Assistant in Lakeland, Florida. Licensed in Florida. Registered with an NPI since 2006.

Licensed in
FL
In the registry since
2006
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

1324 Lakeland Hills Blvd
Lakeland, FL 33805-4543
Phone: (863) 687-1132
Fax: (863) 687-1439
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA9103316 (FL)

Record details

NPI number1508889254
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorNo
NPI enumeratedJuly 25, 2006
Last updated in NPPESMay 5, 2010

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