Provider Demographics
NPI:1245819937
Name:GRAHAM, HARIETTE ALISIA (FNP)
Entity type:Individual
Prefix:
First Name:HARIETTE
Middle Name:ALISIA
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:HARIETTE
Other - Middle Name:ALISIA
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:9310 SW 221ST ST
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33190-1448
Mailing Address - Country:US
Mailing Address - Phone:917-535-6978
Mailing Address - Fax:
Practice Address - Street 1:9310 SW 221ST ST
Practice Address - Street 2:
Practice Address - City:CUTLER BAY
Practice Address - State:FL
Practice Address - Zip Code:33190-1448
Practice Address - Country:US
Practice Address - Phone:917-535-6978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11004463363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty