Provider Demographics
NPI:1265200158
Name:TROUBLEFIELD, TAMIKA HASLAM (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:HASLAM
Last Name:TROUBLEFIELD
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S FLORIDA AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-3809
Mailing Address - Country:US
Mailing Address - Phone:863-732-7200
Mailing Address - Fax:
Practice Address - Street 1:2600 S FLORIDA AVE STE 105
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-3809
Practice Address - Country:US
Practice Address - Phone:863-732-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9407940163WP0808X
FL11037782363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health