1760753917 NPI number — TOSHA A HARRIS NNP

Table of content: TOSHA A HARRIS NNP (NPI 1760753917)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760753917 NPI number — TOSHA A HARRIS NNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
TOSHA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NNP
Provider Gender Code:
F

Provider's Other Name Information

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

NPI Number Information

NPI Number:
1760753917
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/15/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 N DUNLAP ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-2800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-287-4800
Provider Business Mailing Address Fax Number:
901-287-4845

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 N DUNLAP ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38103-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-287-4800
Provider Business Practice Location Address Fax Number:
901-287-4845
Provider Enumeration Date:
01/19/2012

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: 363LN0000X , with the licence number:  AP09213 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LN0000X , with the licence number: 16352 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 06588270 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".