Provider Demographics
NPI:1033409628
Name:HARRIS, ERIC (FNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:HARRIS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N MAIN ST
Mailing Address - Street 2:STE 3
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3106
Mailing Address - Country:US
Mailing Address - Phone:937-277-9371
Mailing Address - Fax:937-277-7734
Practice Address - Street 1:6611 CLYO RD
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-2786
Practice Address - Country:US
Practice Address - Phone:937-208-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH12264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily