Provider Demographics
NPI:1013936525
Name:HARRIS, ROBIN (APN)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:HARRIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N GALLOWAY RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33815-7241
Mailing Address - Country:US
Mailing Address - Phone:816-221-1024
Mailing Address - Fax:
Practice Address - Street 1:501 N GALLOWAY RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33815-7241
Practice Address - Country:US
Practice Address - Phone:816-221-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5912363LF0000X
VA0024170510363LF0000X
FL9447935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8936145Medicaid
TN3902158Medicaid
TN103I897117Medicare PIN
GA890000316Medicare PIN
TN3902158Medicaid
VAVVI777B288Medicare PIN
TNS73346Medicare UPIN