Provider Demographics
NPI:1780429944
Name:HARRIS, RANDE ALEXIS
Entity type:Individual
Prefix:
First Name:RANDE
Middle Name:ALEXIS
Last Name:HARRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8762 MC GLOTHLIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-6438
Mailing Address - Country:US
Mailing Address - Phone:904-776-5966
Mailing Address - Fax:
Practice Address - Street 1:8762 MC GLOTHLIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210-6438
Practice Address - Country:US
Practice Address - Phone:904-776-5966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-28
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist