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

Rafaella Izar Wallace, ANP

Individual provider Gerontology Nurse Practitioner · NPI 1821469107

Rafaella Izar Wallace, ANP is a Nurse Practitioner in Fort Worth, Texas. Qualified in 2015, 11 years ago. Practices with Texas Oncology PA, a 1,005-clinician group, accepts Medicare assignment and offers telehealth. Licensed in Texas.

Years since qualifying
11
Licensed in
TX
In the registry since
2015
Specialties on file
2

Practice location Address checks out

500 S Henderson St Ste 200
Fort Worth, TX 76104-2154
Phone: (817) 413-1500
Fax: (817) 413-1499
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Gerontology Nurse Practitioner (primary) Taxonomy 363LG0600X · Licence AP129253 (TX)
Adult Health Nurse Practitioner Taxonomy 363LA2200X · Licence AP129253 (TX)

Record details

NPI number1821469107
Entity typeIndividual (Type 1)
GenderFemale
Credentials ANP
Sole proprietorNo
NPI enumeratedOctober 13, 2015
Last updated in NPPESDecember 1, 2021
Certification dateDecember 1, 2021

Medicare enrollment

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

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2015 (11 years in practice)
Group practice Texas Oncology Pa — 1005 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fort Worth