Healthcare Provider Details

I. General information

NPI: 1144145137
Provider Name (Legal Business Name): HARRISON HETHERSHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MORTON PLANT ST STE 301
CLEARWATER FL
33756-3395
US

IV. Provider business mailing address

5901 E FOWLER AVE STE 100
TEMPLE TERRACE FL
33617-2305
US

V. Phone/Fax

Practice location:
  • Phone: 727-461-6026
  • Fax:
Mailing address:
  • Phone: 813-987-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN11049296
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN9503237
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: