Healthcare Provider Details

I. General information

NPI: 1457295396
Provider Name (Legal Business Name): MADELINE HARRIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL STE A200
ENCINITAS CA
92024-1350
US

IV. Provider business mailing address

477 N EL CAMINO REAL STE A200
ENCINITAS CA
92024-1350
US

V. Phone/Fax

Practice location:
  • Phone: 858-766-6007
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95039278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: