Healthcare Provider Details

I. General information

NPI: 1023970795
Provider Name (Legal Business Name): LAMONT HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

13800 VETERANS WAY
ORLANDO FL
32827-7401
US

IV. Provider business mailing address

17874 HITHER HILLS CIR
WINTER GARDEN FL
34787-8511
US

V. Phone/Fax

Practice location:
  • Phone: 301-257-5405
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001282147
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: