Provider Demographics
NPI:1740978451
Name:HARRIS, JANOVIA
Entity type:Individual
Prefix:
First Name:JANOVIA
Middle Name:
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 1:9225 BAY PLAZA BLVD STE 417
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-4412
Mailing Address - Country:US
Mailing Address - Phone:813-252-7707
Mailing Address - Fax:
Practice Address - Street 1:3814 HUNT RD UNIT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2448
Practice Address - Country:US
Practice Address - Phone:850-345-5253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL172V00000X
251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Yes172V00000XOther Service ProvidersCommunity Health Worker