Healthcare Provider Details

I. General information

NPI: 1669392536
Provider Name (Legal Business Name): TAMARA PETTIT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2026
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E GRANADA BLVD STE 103
ORMOND BEACH FL
32176-6660
US

IV. Provider business mailing address

129 MAGNOLIA DR
ORMOND BEACH FL
32176-8114
US

V. Phone/Fax

Practice location:
  • Phone: 386-999-1989
  • Fax:
Mailing address:
  • Phone: 386-785-4595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: TAMARA FIELDS PETTIT
Title or Position: THERAPIST/OWNER
Credential: MS, LMFT
Phone: 386-785-4595