Individual
JEANETTA DOLORES HARRIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5577 BLACK RD, MARIANNA, FL 32446-5199
(850) 693-4156
Mailing address
5577 BLACK RD, MARIANNA, FL 32446-5199
(850) 693-4156
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
RN1651632
FL
Other
Enumeration date
01/24/2020
Last updated
01/24/2020
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