Provider Demographics
NPI:1922159987
Name:HARRIS, ALTIA BEVERLY
Entity Type:Individual
Prefix:MS
First Name:ALTIA
Middle Name:BEVERLY
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 1:171 NW 24TH CT
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-3214
Mailing Address - Country:US
Mailing Address - Phone:954-941-3731
Mailing Address - Fax:
Practice Address - Street 1:171 NW 24TH CT
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-3214
Practice Address - Country:US
Practice Address - Phone:954-941-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL372600000X, 3747P1801X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered372600000XNursing Service Related ProvidersAdult Companion
Not Answered3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Not Answered376J00000XNursing Service Related ProvidersHomemaker