MEDICARE: HAILI HARLESS APRN

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	APRN11008425	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	:	1154928612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAILI HARLESS APRN

Provider Business Mailing Address
First Line	:	703 VIRGINIA ST
Second Line	:
City	:	DUNEDIN
State	:	FL
Zip	:	34698-6615
Country	:	US
Telephone Number	:	727-953-3587
Fax Number	:	727-724-4110

Provider Business Practice Location Address
First Line	:	3961 23RD AVE N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-4850
Country	:	US
Telephone Number	:	865-230-0519
Fax Number	:

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

Provider Enumeration Date	:	10/07/2020
Last Update Date	:	11/06/2020

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Directions to “ HAILI HARLESS APRN” Practice Location

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