Healthcare Provider Details

I. General information

NPI: 1336212380
Provider Name (Legal Business Name): NANCY LANE HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 04/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 SE 2ND AVE
DELRAY BEACH FL
33444-3615
US

IV. Provider business mailing address

909 SE 5TH AVE SUITE 201
DELRAY BEACH FL
33483-5172
US

V. Phone/Fax

Practice location:
  • Phone: 561-400-4118
  • Fax:
Mailing address:
  • Phone: 561-900-2498
  • Fax: 888-972-4762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2875
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberARNP 9162696
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: