Provider Demographics
NPI:1730867714
Name:HARTFIELD, WILLENA
Entity type:Individual
Prefix:
First Name:WILLENA
Middle Name:
Last Name:HARTFIELD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89715
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33689-0411
Mailing Address - Country:US
Mailing Address - Phone:518-365-3665
Mailing Address - Fax:
Practice Address - Street 1:4391 LEEWARD RIDGE DR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619-6797
Practice Address - Country:US
Practice Address - Phone:518-365-3665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-10
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY22HA11894921744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management