Healthcare Provider Details

I. General information

NPI: 1295449767
Provider Name (Legal Business Name): LINDSEY K HARRISON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4205 BELFORT RD STE 3075
JACKSONVILLE FL
32216-1475
US

IV. Provider business mailing address

4205 BELFORT RD STE 3075
JACKSONVILLE FL
32216-1475
US

V. Phone/Fax

Practice location:
  • Phone: 904-296-5785
  • Fax:
Mailing address:
  • Phone: 904-296-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9116843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: