1790993905 NPI number — MS. TANNA LOU HARRIS M.ED.,C.C.C.,SLP

Table of content: MS. TANNA LOU HARRIS M.ED.,C.C.C.,SLP (NPI 1790993905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790993905 NPI number — MS. TANNA LOU HARRIS M.ED.,C.C.C.,SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARRIS
Provider First Name:
TANNA
Provider Middle Name:
LOU
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED.,C.C.C.,SLP
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:
1790993905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 DOUGLAS AVE
Provider Second Line Business Mailing Address:
SUITE 1030
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-2593
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-617-1323
Provider Business Mailing Address Fax Number:
407-788-1030

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 DOUGLAS AVE
Provider Second Line Business Practice Location Address:
SUITE 1030
Provider Business Practice Location Address City Name:
ALTAMONTE SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32714-2593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-617-1323
Provider Business Practice Location Address Fax Number:
407-788-1030
Provider Enumeration Date:
05/19/2007

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: 235Z00000X , with the licence number:  SA4318 , 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: 887044600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: S2323 . This is a "SPEECH PATHOLOGIST" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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