MEDICARE: MARQUITA SHANTA HARRIS PMHNP-BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	5016504	NC

General Provider Information

NPI Number	:	1720713522
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARQUITA SHANTA HARRIS PMHNP-BC

Provider Business Mailing Address
First Line	:	3835 N FREEWAY BLVD STE 100
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-1954
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	704 CROMWELL DR STE A
Second Line	:
City	:	GREENVILLE
State	:	NC
Zip	:	27858-5894
Country	:	US
Telephone Number	:	252-486-6573
Fax Number	:	855-595-2926

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

Provider Enumeration Date	:	07/18/2022
Last Update Date	:	04/13/2026

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