Basic Information
Provider Information
NPI: 1043281140
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HARWOOD-NUSS
FirstName: ANN
MiddleName: LATIMER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 44008
Address2: UFJP PROVIDER ENROLLMENT
City: JACKSONVILLE
State: FL
PostalCode: 322314008
CountryCode: US
TelephoneNumber: 9042443660
FaxNumber: 9042443425
Practice Location
Address1: 655 W 8TH ST
Address2: UFJP EMERGENCY MEDICINE
City: JACKSONVILLE
State: FL
PostalCode: 322096511
CountryCode: US
TelephoneNumber: 9042447234
FaxNumber: 9042444771
Other Information
ProviderEnumerationDate: 01/28/2006
LastUpdateDate: 02/05/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000XME38384FLY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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