Provider Demographics
NPI:1770727729
Name:HARRIS, NATASHA KAYANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:NATASHA
Middle Name:KAYANN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 FORT HAMILTON PKWY FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-1916
Mailing Address - Country:US
Mailing Address - Phone:929-491-7333
Mailing Address - Fax:
Practice Address - Street 1:3923 FORT HAMILTON PKWY FL 2
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-1916
Practice Address - Country:US
Practice Address - Phone:929-491-7333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF337755363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF337755-1Medicaid
NY546742-1Medicaid