Zandra Wynette Wallace
Zandra Wynette Wallace is an Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Tampa, Florida. Practices as a sole proprietor. Licensed in Florida.
- Licensed in
- FL
- In the registry since
- 2022
Practice location Address checks out
20316 Natures Corner DrTampa, FL 33647-3580
Phone: (813) 575-8108
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Specialties & licences
| Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility (primary) | Taxonomy 320900000X (FL) |
|---|
Record details
| NPI number | 1053063412 |
|---|---|
| Entity type | Individual (Type 1) |
| Gender | Female |
| Sole proprietor | Yes |
| NPI enumerated | January 26, 2022 |
| Last updated in NPPES | January 26, 2022 |
| Certification date | January 26, 2022 |
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