Provider Demographics
NPI:1922629591
Name:MORRIS, JEREMY HARRISON (FNP-C, APRN)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:HARRISON
Last Name:MORRIS
Suffix:
Gender:M
Credentials:FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1865 EDGE AVE
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2971
Mailing Address - Country:US
Mailing Address - Phone:850-418-0459
Mailing Address - Fax:
Practice Address - Street 1:1001 COLLEGE BLVD W STE D
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1049
Practice Address - Country:US
Practice Address - Phone:850-389-8333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007023363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily