Provider Demographics
NPI:1407377070
Name:VINCENT, HARRIET TAYLOR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:HARRIET
Middle Name:TAYLOR
Last Name:VINCENT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1820
Mailing Address - Country:US
Mailing Address - Phone:304-640-1917
Mailing Address - Fax:
Practice Address - Street 1:106 MIDTOWN AVE
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1773
Practice Address - Country:US
Practice Address - Phone:434-395-2102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-04
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175034363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner