Provider Demographics
NPI:1245238781
Name:HARRIS, JUDY A (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:A
Last Name:HARRIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3196 FERNS GLEN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-2304
Mailing Address - Country:US
Mailing Address - Phone:850-668-2224
Mailing Address - Fax:
Practice Address - Street 1:7121 COASTAL HWY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-2918
Practice Address - Country:US
Practice Address - Phone:850-577-2444
Practice Address - Fax:850-577-2015
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1454272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily