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NPI Code Detail

MEDICARE: MR. SEREN DEVOL WALLEN PA-C

MEDICARE: MR. SEREN DEVOL WALLEN PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AS0400XSurgical Physician AssistantPA9103985FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447336235
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SEREN DEVOL WALLEN PA-C
Provider Business Mailing Address
First Line : 3000 MEDICAL PARK DR STE 320
Second Line :
City : TAMPA
State : FL
Zip : 33613-4681
Country : US
Telephone Number : 813-336-5766
Fax Number :
Provider Business Practice Location Address
First Line : 4612 N HABANA AVE
Second Line : 2ND FL
City : TAMPA
State : FL
Zip : 33614-7101
Country : US
Telephone Number : 813-321-6580
Fax Number : 813-321-6581
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2006
Last Update Date : 02/10/2026

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