Provider Demographics
NPI:1891288742
Name:WALLACE, CARIN LYNNAE (FNP)
Entity type:Individual
Prefix:
First Name:CARIN
Middle Name:LYNNAE
Last Name:WALLACE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 748817
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-8817
Mailing Address - Country:US
Mailing Address - Phone:813-286-0033
Mailing Address - Fax:813-282-1806
Practice Address - Street 1:5985 SILVER FALLS RUN STE 100
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-1291
Practice Address - Country:US
Practice Address - Phone:941-202-2055
Practice Address - Fax:877-550-1635
Is Sole Proprietor?:No
Enumeration Date:2018-06-14
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP137578363LF0000X
FLF04180557363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily