Healthcare Provider Details

I. General information

NPI: 1487348561
Provider Name (Legal Business Name): RACHEL ELIZABETH WAKEFIELD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AUSTIN E WAKEFIELD

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4014 GUNN HWY STE 140
TAMPA FL
33618-8787
US

IV. Provider business mailing address

4014 GUNN HWY STE 140
TAMPA FL
33618-8787
US

V. Phone/Fax

Practice location:
  • Phone: 813-923-9905
  • Fax:
Mailing address:
  • Phone: 813-923-9905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-2826261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: