Provider Demographics
NPI:1093115461
Name:HARRIS, TICEY RENE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TICEY
Middle Name:RENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 SAN GABRIEL AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89002-9433
Mailing Address - Country:US
Mailing Address - Phone:702-354-5032
Mailing Address - Fax:
Practice Address - Street 1:6160 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89108-2659
Practice Address - Country:US
Practice Address - Phone:702-209-3900
Practice Address - Fax:725-269-1554
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVAPRN001849363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care