Provider Demographics
NPI:1194946848
Name:HARRIS, FELICIA CECILIA (NNP)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:CECILIA
Last Name:HARRIS
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:MS
Other - First Name:FELICIA
Other - Middle Name:CECILIA
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NNP
Mailing Address - Street 1:15595 LAS POSAS DR
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92251-1987
Mailing Address - Country:US
Mailing Address - Phone:951-247-5869
Mailing Address - Fax:760-323-6333
Practice Address - Street 1:1150 N INDIAN CAYON DR
Practice Address - Street 2:
Practice Address - City:PAML SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92263
Practice Address - Country:US
Practice Address - Phone:760-323-6430
Practice Address - Fax:760-323-6333
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN426647363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal