Provider Demographics
NPI:1326709023
Name:HARRIS, CHAKITA S
Entity Type:Individual
Prefix:
First Name:CHAKITA
Middle Name:S
Last Name:HARRIS
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 1:1239 SIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-4202
Mailing Address - Country:US
Mailing Address - Phone:863-595-8589
Mailing Address - Fax:
Practice Address - Street 1:1239 SIDNEY AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4202
Practice Address - Country:US
Practice Address - Phone:863-595-8589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15400-162-576-6560207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory ImmunologyGroup - Single Specialty