1700834611 NPI number — ALANNA T. HARRIS MD

Table of content: ALANNA T. HARRIS MD (NPI 1700834611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700834611 NPI number — ALANNA T. HARRIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
ALANNA
Provider Middle Name:
T.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURK
Provider Other First Name:
ALANNA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700834611
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 N HIATUS RD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEMBROKE PINES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33026-5213
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-437-4800
Provider Business Mailing Address Fax Number:
954-437-6628

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
MEMORIAL HOSPITAL SOUTH
Provider Second Line Business Practice Location Address:
3600 WASHINGTON STREET
Provider Business Practice Location Address City Name:
HOLLYWOOD
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33021-8216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
954-518-5230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  ME71887 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 258176100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101621700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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