Provider Demographics
NPI:1578597944
Name:HARRISON, DORENE ANITA (MSN, FNP,CRNFA)
Entity Type:Individual
Prefix:MS
First Name:DORENE
Middle Name:ANITA
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MSN, FNP,CRNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 NIGHTHAWK AVE
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-2178
Mailing Address - Country:US
Mailing Address - Phone:702-340-4463
Mailing Address - Fax:
Practice Address - Street 1:3599 W HILLSBORO BLVD
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-9404
Practice Address - Country:US
Practice Address - Phone:954-333-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9322648363LF0000X
NVAPN001016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP44609Medicare UPIN