Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 28885 | TN |
NPI | 1003400912 |
---|---|
Provider Name | Shacora Harris |
First Address | Antioch, TN 37013-1018 |
Second Address | Antioch, TN 37013-1018 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2021 |
Last Update Date | 22/02/2021 |