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General NPI Number Information
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NPI Number | 1285697920
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Entity Type | Individual
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Provider Name | ANDREA SUZANNE HARRISON A.T.C./L
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Gender | Female
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Dates
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Enumeration Date | 04/11/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1768 PARK CENTER DR STE. 200
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City | ORLANDO
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State | FL
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Zip | 32835-6200
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Country | US
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Telephone | 407-352-1550
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Fax | 407-447-7582
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Provider Business Mailing Address
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Address Line | 900 THOMPSON CIR NW
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City | WINTER HAVEN
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State | FL
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Zip | 33881-2360
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Country | US
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Telephone | 954-290-7491
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AL1378
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License Number State | FL
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