Healthcare Provider Details

I. General information

NPI: 1285559120
Provider Name (Legal Business Name): DERRICK JAMES HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1953 GULF BAY LN
PENSACOLA FL
32506-6086
US

IV. Provider business mailing address

1953 GULF BAY LN
PENSACOLA FL
32506-6086
US

V. Phone/Fax

Practice location:
  • Phone: 850-380-6200
  • Fax:
Mailing address:
  • Phone: 850-380-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License NumberH368891900000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: