Provider Demographics
NPI:1609395110
Name:HARRIS, LISA MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 JENKS AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2568
Mailing Address - Country:US
Mailing Address - Phone:850-215-4060
Mailing Address - Fax:850-695-9176
Practice Address - Street 1:803 JENKS AVE STE 1
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2568
Practice Address - Country:US
Practice Address - Phone:850-215-4060
Practice Address - Fax:850-695-9176
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-15
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN271169363LP0808X, 364SA2200X
FLAPRN10011000394364SA2200X
NMCNS-00256364SA2200X
FLAPRN11000392363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health