Provider Demographics
NPI:1376191072
Name:HARRIS, CARLITTA THERESA
Entity type:Individual
Prefix:
First Name:CARLITTA
Middle Name:THERESA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 BROOKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3834
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 SCHOOL STREET SUITE
Practice Address - Street 2:SUITE 200
Practice Address - City:SW
Practice Address - State:DC
Practice Address - Zip Code:20016
Practice Address - Country:US
Practice Address - Phone:703-752-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181043363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty