MEDICARE: JALONNA HARRIS MSN, APRN, AGNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	11042409	FL
2	363L00000X	Nurse Practitioner	11042409	FL
3	363LP2300X	Primary Care Nurse Practitioner	11042409	FL

General Provider Information

NPI Number	:	1750254421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALONNA HARRIS MSN, APRN, AGNP-C

Provider Business Mailing Address
First Line	:	11874 LAKE LUCAYA DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33579-4111
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5101 E BUSCH BLVD STE 11
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-5380
Country	:	US
Telephone Number	:	813-899-9797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/27/2025
Last Update Date	:	06/25/2026

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