Individual ProviderTina Gayle WallaceLicensed Vocational NurseNursing Service ProvidersPractice Address755 S Beckham Ave, Tyler, TX 75701-1903(903) 534-4684PECOS EnrollmentBased on the most recent information from CMS, provider Tina Gayle Wallace does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 2:50 PM.Profile DetailsProvider ID1881234219Provider TypeIndividualFull NameWallace, Tina GayleGenderFemaleSole ProprietorNoEnumeration Date1/14/2020Last Updated1/14/2020Contact InformationPractice LocationPractice Address755 S Beckham Ave, Tyler, TX 75701-1903Phone(903) 534-4684FaxUnlisted FaxMailing LocationMailing Address755 S Beckham Ave, Tyler, TX 75701-1903PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode164X00000XPrimaryDescriptionLicensed Vocational NurseNursing Service ProvidersLicense349630Texas