Healthcare Provider Details

I. General information

NPI: 1164724712
Provider Name (Legal Business Name): JENNIFER LEIGH HARRISON RN, NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JENNIFER LEIGH CHRISTOFFERSEN RN, NP-C

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 12/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7938 STRATFORD LN
ATLANTA GA
30350-4159
US

IV. Provider business mailing address

6626 STATION DR
CLERMONT GA
30527-1559
US

V. Phone/Fax

Practice location:
  • Phone: 770-804-9479
  • Fax: 770-396-7942
Mailing address:
  • Phone: 706-499-8351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN159235 NP
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: