Provider Demographics
NPI:1811795776
Name:HARRIS, ANDREA (RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:HARRIS
Suffix:
Gender:
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 WORLD OF TENNIS SQ
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78738-1104
Mailing Address - Country:US
Mailing Address - Phone:512-639-0287
Mailing Address - Fax:
Practice Address - Street 1:129 WORLD OF TENNIS SQ
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78738-1104
Practice Address - Country:US
Practice Address - Phone:512-639-0287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-06
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX874217163W00000X, 163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163W00000XNursing Service ProvidersRegistered Nurse