Provider Demographics
NPI:1336212380
Name:HARRIS, NANCY LANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LANE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SE 5TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33483-5172
Mailing Address - Country:US
Mailing Address - Phone:561-900-2498
Mailing Address - Fax:888-972-4762
Practice Address - Street 1:55 SE 2ND AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33444-3615
Practice Address - Country:US
Practice Address - Phone:561-400-4118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2875363L00000X
FLARNP 9162696363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004494Medicaid
SCNP0019Medicaid
SCP00691785OtherRR MEDICARE
SC196631OtherMEDCOST
SCS77644Medicare PIN
SCP00691785OtherRR MEDICARE
SCS77644Medicare UPIN