Healthcare Provider Details

I. General information

NPI: 1336344142
Provider Name (Legal Business Name): WENDY M HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1045 US HIGHWAY 331 S STE D
DEFUNIAK SPRINGS FL
32435-3379
US

IV. Provider business mailing address

1005 MAR WALT DR
FORT WALTON BEACH FL
32547-6707
US

V. Phone/Fax

Practice location:
  • Phone: 850-892-3366
  • Fax: 833-451-2227
Mailing address:
  • Phone: 850-863-8150
  • Fax: 850-863-4152

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11047234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: