MEDICARE: MISS DONTRIA HARRIS

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	332B00000X	Durable Medical Equipment & Medical Supplies		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER	FL	SUPPLY

General Provider Information

NPI Number	:	1114677325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS DONTRIA HARRIS

Provider Business Mailing Address
First Line	:	4553 LIMERICK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9173
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4553 LIMERICK DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33610-9173
Country	:	US
Telephone Number	:	941-883-8319
Fax Number	:

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

Provider Enumeration Date	:	03/29/2022
Last Update Date	:	03/29/2022

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Directions to “ MISS DONTRIA HARRIS ” Practice Location

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