MEDICARE: MARCIANN HARRIS NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	89947	CO
2	363L00000X	Nurse Practitioner	APRN11002870	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053393421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIANN HARRIS NP

Provider Business Mailing Address
First Line	:	4205 BELFORT RD STE 4015
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-3623
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4205 BELFORT RD STE 2069
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-1471
Country	:	US
Telephone Number	:	904-450-8500
Fax Number	:	904-296-0279

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	11/11/2022

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