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

Phillip Tyler Wallace, APRN

Individual provider Nurse Practitioner · NPI 1821647447

Phillip Tyler Wallace, APRN is a Nurse Practitioner in Jacksonville, Florida. Qualified in 2019, 7 years ago. Practices with Respiratory Critical Care and Sleep Medicine Associates, Inc, a 42-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Florida.

Years since qualifying
7
Licensed in
FL
In the registry since
2019
What do these letters mean?
APRN — Advanced Practice Registered Nurse
The umbrella licence covering nurse practitioners, midwives, anaesthetists and clinical nurse specialists.

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Practice location Address checks out

4500 San Pablo Rd S
Jacksonville, FL 32224-1865
Phone: (904) 953-2000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1325 San Marco Blvd Ste 300, Jacksonville, FL 32207-8567 — (904) 253-6910

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X · Licence APRN11003275 (FL)

Record details

NPI number1821647447
Entity typeIndividual (Type 1)
GenderMale
Credentials APRN
Sole proprietorNo
NPI enumeratedSeptember 6, 2019
Last updated in NPPESJune 10, 2026
Certification dateJune 10, 2026
Mailing addressPo Box 860912, Minneapolis, MN 55486-0912

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Respiratory Critical Care And Sleep Medicine Associates,Inc — 42 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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