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General NPI Number Information
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NPI Number | 1588276943
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Entity Type | Individual
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Provider Name | JADEN T HARRIS
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Gender | Male
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 5650 BOLLETTIERI BLVD
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City | BRADENTON
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State | FL
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Zip | 34210-2211
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Country | US
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Telephone | 941-392-2264
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Fax |
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Provider Business Mailing Address
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Address Line | 2205 MONCRIEFF ST
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City | AUGUSTA
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State | GA
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Zip | 30906-8905
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Country | US
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Telephone | 941-392-2264
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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 | AL7039
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License Number State | FL
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