Healthcare Provider Details

I. General information

NPI: 1881450054
Provider Name (Legal Business Name): MADISON B HARKNESS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2024
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15891 SILVERHILL AVE RM 25
SILVERHILL AL
36576-3877
US

IV. Provider business mailing address

2744 GULF BREEZE PKWY
GULF BREEZE FL
32563-3091
US

V. Phone/Fax

Practice location:
  • Phone: 850-934-5713
  • Fax: 850-934-0379
Mailing address:
  • Phone: 509-345-7138
  • Fax: 850-934-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-151756
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11031220
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: