Provider Demographics
NPI:1609502657
Name:HARRIS, JEZWAH E (FNP-BC, MEP-C, NE-BC)
Entity type:Individual
Prefix:DR
First Name:JEZWAH
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:M
Credentials:FNP-BC, MEP-C, NE-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11295 BISCAYNE BLVD PH 7
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33181-3497
Mailing Address - Country:US
Mailing Address - Phone:323-229-2070
Mailing Address - Fax:754-331-5445
Practice Address - Street 1:16215 BISCAYNE BLVD STE 131
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4300
Practice Address - Country:US
Practice Address - Phone:786-744-5152
Practice Address - Fax:754-331-5445
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-30
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA95031847363L00000X, 363L00000X
NY355285363L00000X
AZ314884363L00000X
FLAPRN11035589363L00000X
CA95101575163WA2000X, 163WC0200X, 163WE0003X, 163WS0121X, 207N00000X
NVRN97140163WA2000X, 207N00000X
FL9565726363LP2300X
MA2340696163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No163WA2000XNursing Service ProvidersRegistered NurseAdministrator
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No163W00000XNursing Service ProvidersRegistered Nurse