Healthcare Provider Details

I. General information

NPI: 1962474148
Provider Name (Legal Business Name): CARY ELIZABETH HARRISON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST
JACKSONVILLE FL
32214-5005
US

IV. Provider business mailing address

1850 SENTRY OAK CT
GREEN COVE SPRINGS FL
32043-3764
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-7680
  • Fax: 904-542-7467
Mailing address:
  • Phone: 904-529-9953
  • Fax: 904-542-7467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number37186-020
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: