Healthcare Provider Details

I. General information

NPI: 1073052619
Provider Name (Legal Business Name): JACQUELINE MARIE HARRISON ARNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2017
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33044 HWY 27
HAINES CITY FL
33844-7621
US

IV. Provider business mailing address

114 LAKE MARIAM WAY
WINTER HAVEN FL
33884-3818
US

V. Phone/Fax

Practice location:
  • Phone: 863-422-4977
  • Fax:
Mailing address:
  • Phone: 863-287-8864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number9243641
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number9243641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: