Provider Demographics
NPI:1922086867
Name:HARRISON, PATRICIA (M D)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:HARRISON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 N. BEAL PKWY
Mailing Address - Street 2:SUITE B-1
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32547-1481
Mailing Address - Country:US
Mailing Address - Phone:850-862-4960
Mailing Address - Fax:850-862-4529
Practice Address - Street 1:1025 BEAL PKWY NW
Practice Address - Street 2:SUITE B-1
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1481
Practice Address - Country:US
Practice Address - Phone:850-862-4960
Practice Address - Fax:850-862-4529
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-31
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME717952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253694300Medicaid
FL253694300Medicaid
FLE0325AMedicare PIN