Provider Demographics
NPI:1639436926
Name:WALLUM, ALLISON MARIE (PA-C)
Entity type:Individual
Prefix:MS
First Name:ALLISON
Middle Name:MARIE
Last Name:WALLUM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:3345 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5220
Mailing Address - Country:US
Mailing Address - Phone:352-742-2050
Mailing Address - Fax:352-343-0154
Practice Address - Street 1:3345 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5220
Practice Address - Country:US
Practice Address - Phone:352-742-2050
Practice Address - Fax:352-343-0154
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9106452363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical