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General NPI Number Information
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NPI Number | 1801280862
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Entity Type | Individual
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Provider Name | DR. TANIKA RAE-ANN HARLIS
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Gender | Female
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Dates
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Enumeration Date | 03/26/2015
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Last Update Date | 10/07/2021
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Provider Practice Location Address
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Address Line | 1680 SE LYNGATE DR STE 201
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4300
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Country | US
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Telephone | 772-210-3339
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Fax | 772-404-7819
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Provider Business Mailing Address
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Address Line | 1680 SE LYNGATE DR STE 201
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34952-4300
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Country | US
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Telephone | 772-210-3339
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Fax | 772-404-7819
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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 | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | PO3923
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License Number State | FL
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