Healthcare Provider Details

I. General information

NPI: 1346585866
Provider Name (Legal Business Name): ADAM CHRISTOPHER HARKIEWICZ P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2012
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

861 CORONADO CENTER DR STE 100
HENDERSON NV
89052-3992
US

IV. Provider business mailing address

151 SOUTHHALL LN STE 300
MAITLAND FL
32751-7172
US

V. Phone/Fax

Practice location:
  • Phone: 702-257-7546
  • Fax: 702-870-4824
Mailing address:
  • Phone: 407-216-2691
  • Fax: 702-307-5480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA 1397
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 1397
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberPA1397
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: