Healthcare Provider Details

I. General information

NPI: 1295651693
Provider Name (Legal Business Name): MACY FIELDS NP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 168TH ST
MC ALPIN FL
32062-2366
US

IV. Provider business mailing address

11303 168TH ST
MC ALPIN FL
32062-2366
US

V. Phone/Fax

Practice location:
  • Phone: 386-209-3024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number11048412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: