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General NPI Number Information
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NPI Number | 1033046248
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Entity Type | Individual
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Provider Name | GRACE CHRISTIANNE MANUELA WALLACE WHNP
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Gender | Female
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Dates
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Enumeration Date | 05/04/2026
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Last Update Date | 05/04/2026
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Provider Practice Location Address
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Address Line | 1600 W COMMERCIAL BLVD
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-3006
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Country | US
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Telephone | 954-318-1620
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Fax |
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Provider Business Mailing Address
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Address Line | 207 VARSITY CIR
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-2835
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Country | US
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Telephone | 407-496-7157
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | APRN11047255
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License Number State | FL
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