Provider Demographics
NPI:1801280862
Name:HARLIS, TANIKA RAE-ANN
Entity type:Individual
Prefix:DR
First Name:TANIKA
Middle Name:RAE-ANN
Last Name:HARLIS
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 1:1680 SE LYNGATE DR STE 201
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-4300
Mailing Address - Country:US
Mailing Address - Phone:772-210-3339
Mailing Address - Fax:772-404-7819
Practice Address - Street 1:1680 SE LYNGATE DR STE 201
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-4300
Practice Address - Country:US
Practice Address - Phone:772-210-3339
Practice Address - Fax:772-404-7819
Is Sole Proprietor?:No
Enumeration Date:2015-03-26
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3923213EP1101X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1801280862OtherNPI