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NPI Code Detail

MEDICARE: JADEN T HARRIS

MEDICARE: JADEN T 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
12255A2300XAthletic TrainerAL7039FL

General Provider Information

NPI Number : 1588276943
Entity Type Code : Individual
Provider Name (Legal Business Name) : JADEN T HARRIS
Provider Business Mailing Address
First Line : 2205 MONCRIEFF ST
Second Line :
City : AUGUSTA
State : GA
Zip : 30906-8905
Country : US
Telephone Number : 941-392-2264
Fax Number :
Provider Business Practice Location Address
First Line : 5650 BOLLETTIERI BLVD
Second Line :
City : BRADENTON
State : FL
Zip : 34210-2211
Country : US
Telephone Number : 941-392-2264
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2020
Last Update Date : 12/29/2025

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