Provider Demographics
NPI:1609575216
Name:HARPER, JAKE GALAN
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:GALAN
Last Name:HARPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 SW SUNDANCE TRL
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-8220
Mailing Address - Country:US
Mailing Address - Phone:561-906-1619
Mailing Address - Fax:
Practice Address - Street 1:440 SW SUNDANCE TRL
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-8220
Practice Address - Country:US
Practice Address - Phone:561-906-1619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9452369163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse