Provider Demographics
NPI:1386220473
Name:TAZZIE HARRISON, APRN, PMHNP-BC, LLC
Entity Type:Organization
Organization Name:TAZZIE HARRISON, APRN, PMHNP-BC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAZZIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:352-494-6692
Mailing Address - Street 1:2473 SE STATE ROAD 100
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-8532
Mailing Address - Country:US
Mailing Address - Phone:352-494-6692
Mailing Address - Fax:
Practice Address - Street 1:2473 SE STATE ROAD 100
Practice Address - Street 2:
Practice Address - City:STARKE
Practice Address - State:FL
Practice Address - Zip Code:32091-8532
Practice Address - Country:US
Practice Address - Phone:352-494-6692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-20
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty