Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 5008519 | NC |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 0024173113 | VA |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1060247 | TX |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 80350 | TN |
N | 363LF0000X | Nurse Practitioner - Family Medicine | AC004060 | MD |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APN001047 | NV |
N | 363LF0000X | Nurse Practitioner - Family Medicine | APRN11015163 | FL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | NP000162 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | 2883852 | FL |
NPI | 1053367193 |
---|---|
Provider Name | Ms. Teena Jo Harrison |
First Address | Arlington, VA 22203-4173 |
Second Address | Winston Salem, NC 27103-3097 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 08/12/2021 |