Provider Demographics
NPI:1558609107
Name:HARRISON, TAVANE ELIZABETH (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TAVANE
Middle Name:ELIZABETH
Last Name:HARRISON
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 DAKOTA DUNES BLVD
Mailing Address - Street 2:
Mailing Address - City:DAKOTA DUNES
Mailing Address - State:SD
Mailing Address - Zip Code:57049-5461
Mailing Address - Country:US
Mailing Address - Phone:712-294-7390
Mailing Address - Fax:
Practice Address - Street 1:330 DAKOTA DUNES BLVD
Practice Address - Street 2:
Practice Address - City:DAKOTA DUNES
Practice Address - State:SD
Practice Address - Zip Code:57049-5461
Practice Address - Country:US
Practice Address - Phone:712-294-7390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily