Provider Demographics
NPI:1225410442
Name:HARRIS, TIA COVINGTON (AA-C)
Entity Type:Individual
Prefix:
First Name:TIA
Middle Name:COVINGTON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:AA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:758 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-5314
Mailing Address - Country:US
Mailing Address - Phone:727-470-8377
Mailing Address - Fax:
Practice Address - Street 1:225 S EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4257
Practice Address - Country:US
Practice Address - Phone:262-787-6758
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-24
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAA393367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant