MEDICARE: JACOB PAUL HARRISON FNP

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	208D00000X	General Practice Physician	22912	TN
2	363LF0000X	Family Nurse Practitioner	22912	TN

General Provider Information

NPI Number	:	1114449881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB PAUL HARRISON FNP

Provider Business Mailing Address
First Line	:	1326 PAPERMILL POINTE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1903
Country	:	US
Telephone Number	:	865-219-3506
Fax Number	:

Provider Business Practice Location Address
First Line	:	1328 PAPERMILL POINTE WAY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37909-1903
Country	:	US
Telephone Number	:	865-212-0530
Fax Number	:

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

Provider Enumeration Date	:	07/13/2017
Last Update Date	:	09/13/2023

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