Provider Demographics
NPI:1003553587
Name:HARRIS, TYWANNA EVETTE
Entity Type:Individual
Prefix:
First Name:TYWANNA
Middle Name:EVETTE
Last Name:HARRIS
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 1:10923 GOLDEN SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-4052
Mailing Address - Country:US
Mailing Address - Phone:346-244-3850
Mailing Address - Fax:
Practice Address - Street 1:10923 GOLDEN SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77064-4052
Practice Address - Country:US
Practice Address - Phone:346-244-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNONEOtherN/A