Healthcare Provider Details

I. General information

NPI: 1144969833
Provider Name (Legal Business Name): TORI CHRISTIAN HARRISON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

IV. Provider business mailing address

364 HONEYSUCKLE RD
DOTHAN AL
36305-1140
US

V. Phone/Fax

Practice location:
  • Phone: 334-794-8656
  • Fax: 334-702-7047
Mailing address:
  • Phone: 334-794-8656
  • Fax: 334-702-7047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF05220831
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number1-148575
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: