MEDICARE: DIANA M HARRIS ACNP

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	207RI0011X	Interventional Cardiology Physician	0024177589	VA
2	363LA2100X	Acute Care Nurse Practitioner	0024177589	VA

General Provider Information

NPI Number	:	1740538321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA M HARRIS ACNP

Provider Business Mailing Address
First Line	:	PO BOX 749112
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-9112
Country	:	US
Telephone Number	:	434-295-1000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1221 LEE ST
Second Line	:
City	:	CHARLOTTESVILLE
State	:	VA
Zip	:	22908-0001
Country	:	US
Telephone Number	:	434-924-2706
Fax Number	:

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

Provider Enumeration Date	:	08/29/2012
Last Update Date	:	05/08/2026

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