Healthcare Provider Details

I. General information

NPI: 1528032547
Provider Name (Legal Business Name): DAVID A HARRIS PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 3RD ST STE 103
ROCKLEDGE FL
32955-5788
US

IV. Provider business mailing address

6420 3RD ST STE 103
ROCKLEDGE FL
32955-5788
US

V. Phone/Fax

Practice location:
  • Phone: 321-335-7833
  • Fax: 321-335-7833
Mailing address:
  • Phone: 321-335-7833
  • Fax: 321-335-7833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9102926
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9102926
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: