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: 12/16/2025
Certification Date: 12/16/2025
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 Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16540
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: