Provider Demographics
NPI:1811995889
Name:HARKNESS, DENNIS (PA-C)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:HARKNESS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3120 WATERMAN WAY
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-5252
Mailing Address - Country:US
Mailing Address - Phone:352-343-1216
Mailing Address - Fax:352-343-1582
Practice Address - Street 1:3120 WATERMAN WAY
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5252
Practice Address - Country:US
Practice Address - Phone:352-343-1216
Practice Address - Fax:352-343-1582
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103327363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL292162600Medicaid
FLP00294423Medicare PIN