Healthcare Provider Details

I. General information

NPI: 1053262691
Provider Name (Legal Business Name): JAYE HOLLAND HARRIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 WHITE WATER DR
OCOEE TN
37361-3645
US

IV. Provider business mailing address

119 WHITE WATER DR
OCOEE TN
37361-3645
US

V. Phone/Fax

Practice location:
  • Phone: 423-299-9435
  • Fax:
Mailing address:
  • Phone: 423-299-9435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number6982
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: