Healthcare Provider Details

I. General information

NPI: 1790063246
Provider Name (Legal Business Name): ALYSON BLYTHE HARRIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALYSON BLYTHE HARRIS ARNP

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 04/01/2022
Certification Date: 04/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3509
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 949-917-4896
  • Fax: 941-917-6884
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704346884
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN9265545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: