Provider Demographics
NPI:1346553203
Name:HARKNESS, CAROLI GENIS (PA-C)
Entity Type:Individual
Prefix:
First Name:CAROLI
Middle Name:GENIS
Last Name:HARKNESS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAROLI
Other - Middle Name:
Other - Last Name:GENIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1234 SE MAGNOLIA EXT
Mailing Address - Street 2:UNIT 1
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-3778
Mailing Address - Country:US
Mailing Address - Phone:352-401-1218
Mailing Address - Fax:352-401-1017
Practice Address - Street 1:1234 SE MAGNOLIA EXT
Practice Address - Street 2:UNIT 1
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-3778
Practice Address - Country:US
Practice Address - Phone:352-401-1218
Practice Address - Fax:352-401-1017
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9105492363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002733900Medicaid
FL002733900Medicaid