Healthcare Provider Details

I. General information

NPI: 1497117410
Provider Name (Legal Business Name): JAUREL HARLEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2016
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11260 SULLIVAN ST
RIVERVIEW FL
33578-2140
US

IV. Provider business mailing address

17 DAVIS BLVD SUITE 308
TAMPA FL
33606-3475
US

V. Phone/Fax

Practice location:
  • Phone: 813-689-7571
  • Fax:
Mailing address:
  • Phone: 813-250-2506
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME140773
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: