Healthcare Provider Details

I. General information

NPI: 1770875528
Provider Name (Legal Business Name): RANCE L. HARBOR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 N DALE MABRY HWY STE 200
TAMPA FL
33618-2040
US

IV. Provider business mailing address

14502 N DALE MABRY HWY STE 200
TAMPA FL
33618-2040
US

V. Phone/Fax

Practice location:
  • Phone: 813-695-7187
  • Fax: 813-264-7796
Mailing address:
  • Phone: 813-695-7187
  • Fax: 813-264-7796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS1055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: