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Individual

MRS. STACI HARRIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
CPNP-PC

Contact information

Practice address
621 VICTORIA ST, BRANDON, FL 33510-4313
(813) 655-0292
Mailing address
621 VICTORIA ST, BRANDON, FL 33510-4313
(813) 655-0292

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
9458087
FL
363LP0200X
Pediatric Nurse Practitioner
Primary
ARNP9458087
FL
363LP0200X
Pediatric Nurse Practitioner
RN322649
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0189628
OH
Enumeration date
09/22/2016
Last updated
08/02/2024
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