Provider Demographics
NPI:1285269498
Name:HARRIS, TONIA NAYLENE (RN)
Entity type:Individual
Prefix:
First Name:TONIA
Middle Name:NAYLENE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3402 CORNWALL SQUARE DR APT 301
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3531
Mailing Address - Country:US
Mailing Address - Phone:216-456-4535
Mailing Address - Fax:
Practice Address - Street 1:3402 CORNWALL SQUARE DR APT 301
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3531
Practice Address - Country:US
Practice Address - Phone:216-456-4535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-08
Last Update Date:2020-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9530473163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral PracticeGroup - Single Specialty