Provider Demographics
NPI:1134297286
Name:HARRIS, TERESA A (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BANNING ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-3485
Mailing Address - Country:US
Mailing Address - Phone:302-674-0223
Mailing Address - Fax:302-674-0109
Practice Address - Street 1:200 BANNING ST
Practice Address - Street 2:SUITE 320
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3485
Practice Address - Country:US
Practice Address - Phone:302-674-0223
Practice Address - Fax:302-674-0109
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEL1-0031425164W00000X
DELH-0000170363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEL1-0031425OtherPROF. LICENSE NUMBER
DELH-0000170OtherPROFESSIONAL LICENSE