Provider Demographics
NPI:1093323826
Name:HARRIS-AGYEMAN, PERMERIEA
Entity Type:Individual
Prefix:
First Name:PERMERIEA
Middle Name:
Last Name:HARRIS-AGYEMAN
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 1:283 E SHUEY AVE
Mailing Address - Street 2:
Mailing Address - City:MACCLENNY
Mailing Address - State:FL
Mailing Address - Zip Code:32063-2145
Mailing Address - Country:US
Mailing Address - Phone:904-428-3632
Mailing Address - Fax:
Practice Address - Street 1:283 E SHUEY AVE
Practice Address - Street 2:
Practice Address - City:MACCLENNY
Practice Address - State:FL
Practice Address - Zip Code:32063-2145
Practice Address - Country:US
Practice Address - Phone:904-428-3632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9231625163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse