Provider Demographics
NPI:1578160883
Name:HARRISROGERS HOME HEALTH ORGANIZATION
Entity Type:Organization
Organization Name:HARRISROGERS HOME HEALTH ORGANIZATION
Other - Org Name:HILTON HEAD ISLAND MEDICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOBBIE
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C/DN
Authorized Official - Phone:843-384-9485
Mailing Address - Street 1:7901 4TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-4399
Mailing Address - Country:US
Mailing Address - Phone:843-384-9486
Mailing Address - Fax:843-282-7691
Practice Address - Street 1:7901 4TH ST N STE 300
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-4399
Practice Address - Country:US
Practice Address - Phone:843-384-9486
Practice Address - Fax:843-282-7691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-08
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLTPAN203OtherTELEMEDICINE TPAN
FL1578160883OtherNPI FL
TX1902075666OtherNPI
TXAP683412OtherAPRN LICENSE