Provider Demographics
NPI:1063134187
Name:HARRIS, DIAMOND TIARA (BSN, RN)
Entity type:Individual
Prefix:
First Name:DIAMOND
Middle Name:TIARA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2751 BARKER AVE APT Y31
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-7382
Mailing Address - Country:US
Mailing Address - Phone:191-465-6310
Mailing Address - Fax:
Practice Address - Street 1:2751 BARKER AVE APT Y31
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-7382
Practice Address - Country:US
Practice Address - Phone:191-465-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY801782163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse