Healthcare Provider Details

I. General information

NPI: 1609502657
Provider Name (Legal Business Name): JEZWAH E HARRIS FNP-BC, MEP-C, NE-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2022
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16215 BISCAYNE BLVD STE 131
AVENTURA FL
33160-4300
US

IV. Provider business mailing address

12555 BISCAYNE BLVD PMB 1037
NORTH MIAMI FL
33181
US

V. Phone/Fax

Practice location:
  • Phone: 786-744-5152
  • Fax: 833-973-5949
Mailing address:
  • Phone: 323-229-2070
  • Fax: 786-685-2567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number355285
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number314884
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95031847
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11035589
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number11035589
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11035589
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number11035589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: