Provider Demographics
NPI:1487700449
Name:HARRIS, TASHA JEAN (PA-C)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:JEAN
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 PERIMETER PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-8442
Mailing Address - Country:US
Mailing Address - Phone:800-594-8624
Mailing Address - Fax:
Practice Address - Street 1:514 N BRIGHTLEAF BLVD STE 1610
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4486
Practice Address - Country:US
Practice Address - Phone:919-938-7187
Practice Address - Fax:919-938-7201
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-00216363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical