Healthcare Provider Details

I. General information

NPI: 1548176407
Provider Name (Legal Business Name): YOLANDA TARVER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3198 WHISPERING TRAILS AVE
WINTER HAVEN FL
33884-1808
US

IV. Provider business mailing address

205 S DIXIE DR
HAINES CITY FL
33844-2873
US

V. Phone/Fax

Practice location:
  • Phone: 863-271-9620
  • Fax:
Mailing address:
  • Phone: 863-271-9620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberL21000039564
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: