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General NPI Number Information
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NPI Number | 1912974288
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Entity Type | Individual
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Provider Name | JUDY BAKER HARRISON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/04/2006
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Last Update Date | 04/24/2008
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Provider Practice Location Address
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Address Line | 820 PRUDENTIAL DR SUITE 713
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8210
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Country | US
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Telephone | 904-396-4369
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Fax | 904-346-0864
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Provider Business Mailing Address
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Address Line | PO BOX 863640
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City | ORLANDO
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State | FL
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Zip | 32886-3640
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Country | US
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Telephone | 386-274-7800
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Fax | 386-274-7801
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME38728
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME38728
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License Number State | FL
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