MEDICARE: DR. GARRETT DANIEL HARRISON D.O.

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	390200000X	Student in an Organized Health Care Education/Training Program
2	207V00000X	Obstetrics & Gynecology Physician	OS21537	FL
3	207V00000X	Obstetrics & Gynecology Physician	0102205368	VA
4	207V00000X	Obstetrics & Gynecology Physician	036159184	IL

General Provider Information

NPI Number	:	1326585217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARRETT DANIEL HARRISON D.O.

Provider Business Mailing Address
First Line	:	11945 SAN JOSE BLVD STE 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-262-5333
Fax Number	:

Provider Business Practice Location Address
First Line	:	11945 SAN JOSE BLVD STE 400
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-1627
Country	:	US
Telephone Number	:	904-262-5333
Fax Number	:

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

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	05/29/2025

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