Provider Demographics
NPI:1871849596
Name:HARRIS, THERESA LYON (APRN)
Entity Type:Individual
Prefix:MRS
First Name:THERESA
Middle Name:LYON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APRN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 746638
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6638
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:520 A1A N STE 101
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-2260
Practice Address - Country:US
Practice Address - Phone:904-273-6900
Practice Address - Fax:904-390-7479
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2023-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP1351702363L00000X
FLAPRN1371502363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner