Healthcare Provider Details

I. General information

NPI: 1174191977
Provider Name (Legal Business Name): DR. ALEXIS NICOLE HARRIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2021
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST STE 11100
ORLANDO FL
32804-5570
US

IV. Provider business mailing address

2020 OGDEN AVE STE 330
AURORA IL
60504-5897
US

V. Phone/Fax

Practice location:
  • Phone: 844-407-4070
  • Fax: 630-978-6865
Mailing address:
  • Phone: 630-978-4850
  • Fax: 630-978-6865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME167118
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: