Provider Demographics
NPI:1376350769
Name:HARRISON HOLISTICS LLC
Entity type:Organization
Organization Name:HARRISON HOLISTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:HARRISON
Authorized Official - Suffix:
Authorized Official - Credentials:NP-BC
Authorized Official - Phone:617-417-9275
Mailing Address - Street 1:6115 INDIAN WOOD CIR SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-2964
Mailing Address - Country:US
Mailing Address - Phone:617-417-9275
Mailing Address - Fax:
Practice Address - Street 1:6115 INDIAN WOOD CIR SE
Practice Address - Street 2:
Practice Address - City:MABLETON
Practice Address - State:GA
Practice Address - Zip Code:30126-2964
Practice Address - Country:US
Practice Address - Phone:617-417-9275
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-18
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty