Provider Demographics
NPI:1831909720
Name:HARLEY, TAKIYA LASHAY (RN)
Entity type:Individual
Prefix:
First Name:TAKIYA
Middle Name:LASHAY
Last Name:HARLEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 WHISPER PINE DR
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-1333
Mailing Address - Country:US
Mailing Address - Phone:352-636-6085
Mailing Address - Fax:
Practice Address - Street 1:311 PINE ST
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-5971
Practice Address - Country:US
Practice Address - Phone:352-636-6085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-13
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9295324163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health