Provider Demographics
NPI:1659862969
Name:HARRIS, STAR FAITH
Entity Type:Individual
Prefix:
First Name:STAR
Middle Name:FAITH
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 EMERALD AVE S
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-4972
Mailing Address - Country:US
Mailing Address - Phone:941-237-7935
Mailing Address - Fax:
Practice Address - Street 1:104 EMERALD AVE S
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-4972
Practice Address - Country:US
Practice Address - Phone:941-237-7935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL$$$$$$$$$Medicaid