Healthcare Provider Details

I. General information

NPI: 1770394272
Provider Name (Legal Business Name): JENNIFER LYNN HARRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 07/25/2025
Certification Date: 07/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

IV. Provider business mailing address

6672 NEWARK RD
IMLAY CITY MI
48444-9657
US

V. Phone/Fax

Practice location:
  • Phone: 810-724-0591
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number4704233954
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704233954
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: