MEDICARE: MS. JASMIA NYREE WALLACE FNP

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
1	363LF0000X	Family Nurse Practitioner	95025072	CA
2	363LF0000X	Family Nurse Practitioner	3019056	KY
3	363LF0000X	Family Nurse Practitioner	209027385	IL
4	363LF0000X	Family Nurse Practitioner	C-APN.0100636-C-NP	CO
5	363LF0000X	Family Nurse Practitioner	RN217995	GA
6	363LF0000X	Family Nurse Practitioner	1100729	TX
7	363LF0000X	Family Nurse Practitioner	4704401026	MI
8	363LF0000X	Family Nurse Practitioner	353211	NY
9	363LF0000X	Family Nurse Practitioner	16419	TN
10	363LF0000X	Family Nurse Practitioner	11335	MN
11	363LF0000X	Family Nurse Practitioner	AC005558	MD
12	363LF0000X	Family Nurse Practitioner	10011868	OR
13	363LF0000X	Family Nurse Practitioner	SP028130	PA
14	363LF0000X	Family Nurse Practitioner	LG-0012297	DE
15	363LF0000X	Family Nurse Practitioner	APRN11002307	FL

General Provider Information

NPI Number	:	1932473386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JASMIA NYREE WALLACE FNP

Provider Business Mailing Address
First Line	:	210 ATHENS WAY STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37228-1308
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	210 ATHENS WAY STE 200
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37228-1308
Country	:	US
Telephone Number	:	615-270-3505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2012
Last Update Date	:	08/01/2024

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