Healthcare Provider Details

I. General information

NPI: 1295494078
Provider Name (Legal Business Name): PATRICK MICHAEL HARRIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2021
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 CAPITAL MEDICAL BLVD
TALLAHASSEE FL
32308-4499
US

IV. Provider business mailing address

1800 MICCOSUKEE COMMONS DR APT 909
TALLAHASSEE FL
32308-5438
US

V. Phone/Fax

Practice location:
  • Phone: 850-325-5000
  • Fax:
Mailing address:
  • Phone: 585-991-3678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License NumberRT17372
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: