Provider Demographics
NPI:1295320406
Name:HARRIS, FLORIDA FAYE (MTP)
Entity type:Individual
Prefix:
First Name:FLORIDA
Middle Name:FAYE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MTP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 834
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0014
Mailing Address - Country:US
Mailing Address - Phone:936-328-8011
Mailing Address - Fax:936-328-8011
Practice Address - Street 1:111 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-3237
Practice Address - Country:US
Practice Address - Phone:936-328-8011
Practice Address - Fax:936-328-8011
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)