Healthcare Provider Details

I. General information

NPI: 1649192105
Provider Name (Legal Business Name): TAMARA FIELDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 1ST ST S
WINTER HAVEN FL
33880-4307
US

IV. Provider business mailing address

PO BOX 404
LAKE HAMILTON FL
33851-0404
US

V. Phone/Fax

Practice location:
  • Phone: 352-205-2444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21931
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: