Provider Demographics
NPI:1104443126
Name:HARRIS, VERNIECEA J (MD)
Entity type:Individual
Prefix:
First Name:VERNIECEA
Middle Name:J
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4717
Mailing Address - Country:US
Mailing Address - Phone:904-308-7372
Mailing Address - Fax:
Practice Address - Street 1:4844 DEER LAKE DR W STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-4506
Practice Address - Country:US
Practice Address - Phone:904-738-8690
Practice Address - Fax:904-390-7426
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161530207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine