Provider Demographics
NPI:1316536162
Name:HARRIS, SHEKEDRA NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:SHEKEDRA
Middle Name:NICOLE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MRS
Other - First Name:SHEKEDRA
Other - Middle Name:NICOLE
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN
Mailing Address - Street 1:260 BARRINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:FL
Mailing Address - Zip Code:32344-6760
Mailing Address - Country:US
Mailing Address - Phone:850-242-3734
Mailing Address - Fax:
Practice Address - Street 1:1515 OLD BAINBRIDGE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5340
Practice Address - Country:US
Practice Address - Phone:850-404-6395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-15
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11011924363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily