Mrs Nicole Wallace, PA - Medicare Physician Assistant in Lakeland, FL

Mrs Nicole Wallace, PA is a medicare enrolled "Physician Assistant" in Lakeland, Florida. Her current practice location is 1324 Lakeland Hills Blvd, Lakeland, Florida. You can reach out to her office (for appointments etc.) via phone at (863) 687-1132.

Mrs Nicole Wallace is licensed to practice in Florida (license number PA9103316) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1508889254.

Contact Information

Mrs Nicole Wallace, PA
1324 Lakeland Hills Blvd,
Lakeland, FL 33805-4543
(863) 687-1132
(863) 687-1439

Map and Direction




Provider's Profile

Full NameMrs Nicole Wallace
GenderFemale
SpecialityPhysician Assistant
Location1324 Lakeland Hills Blvd, Lakeland, Florida
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1508889254
  • Provider Enumeration Date: 07/25/2006
  • Last Update Date: 05/05/2010
  Medicare PECOS Information:
  • PECOS PAC ID: 8022040112
  • Enrollment ID: I20050909000439

Medical Identifiers

Medical identifiers for Mrs Nicole Wallace such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1508889254NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
363A00000XPhysician Assistant PA9103316 (Florida)Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mrs Nicole Wallace is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Mrs Nicole Wallace, PA
5026 Fairfax Dr,
Lakeland, FL 33813-2917

Ph: (863) 644-2455
Mrs Nicole Wallace, PA
1324 Lakeland Hills Blvd,
Lakeland, FL 33805-4543

Ph: (863) 687-1132

Reviews and Comments


Physician Assistant Nurses in Lakeland, FL

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Ms. Patricia Anne Keefe, PA-C
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Cory Adam Moogerfeld, PA-C
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Medicare: Accepting Medicare Assignments
Practice Location: 1324 Lakeland Hills Blvd, Lakeland, FL 33805
Phone: 863-687-1100    
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Medicare: Accepting Medicare Assignments
Practice Location: 1417 Lakeland Hills Blvd Ste 201, Lakeland, FL 33805
Phone: 813-701-5804    Fax: 813-291-7615
Katie Reisman Lynch, PA-C
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Medicare: Medicare Enrolled
Practice Location: 1324 Lakeland Hills Blvd, Lakeland, FL 33805
Phone: 863-687-1100    

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.