=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760791750
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DENISE HARRIS RN, FNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2010
-----------------------------------------------------
Last Update Date | 07/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 515 SIXTH AVENUE 1ST FLOOR
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 929-470-9141
-----------------------------------------------------
Fax | 466-967-4126
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 555 HANCOCK ST
-----------------------------------------------------
City | BROOKLYN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11233-1018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-455-4047
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | F-335105-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------