Healthcare Provider Details

I. General information

NPI: 1417867177
Provider Name (Legal Business Name): NICOLE ELIZABETH HARRIS LSWAIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19046 BRUCE B DOWNS BLVD # 1215
TAMPA FL
33647-2434
US

IV. Provider business mailing address

19046 BRUCE B DOWNS BLVD # 1215
TAMPA FL
33647-2434
US

V. Phone/Fax

Practice location:
  • Phone: 813-732-1256
  • Fax:
Mailing address:
  • Phone: 813-732-1256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWIA.SC.70155615
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: