Provider Demographics
NPI:1457647190
Name:HARRISON, EMILY (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10111 FOREST HILL BLVD RM 255
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6141
Mailing Address - Country:US
Mailing Address - Phone:561-377-7131
Mailing Address - Fax:866-219-0330
Practice Address - Street 1:10111 FOREST HILL BLVD RM 255
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6141
Practice Address - Country:US
Practice Address - Phone:561-377-7131
Practice Address - Fax:866-219-0330
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME128626207Q00000X
NJ25MA08903900207Q00000X
NY262897-1207Q00000X
DCMD039946207Q00000X
VA0101249896207Q00000X
FL128626207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6128AOtherMEDICARE