Provider Demographics
NPI:1003114885
Name:HARRIS, ANNETTE KAY (RN)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:KAY
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 RIGGS CIR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8537
Mailing Address - Country:US
Mailing Address - Phone:321-276-3045
Mailing Address - Fax:863-424-2388
Practice Address - Street 1:744 RIGGS CIR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33897-8537
Practice Address - Country:US
Practice Address - Phone:321-276-3045
Practice Address - Fax:863-424-2388
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9272228163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse