Basic Information
| Provider Information | |||||||||
| NPI: | 1659477891 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARBISON | ||||||||
| FirstName: | DANA | ||||||||
| MiddleName: | BIANCA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1940 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8506925862 | ||||||||
| Practice Location | |||||||||
| Address1: | 1940 HARRISON AVE | ||||||||
| Address2: | |||||||||
| City: | PANAMA CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324054542 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8507630017 | ||||||||
| FaxNumber: | 8506925862 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2006 | ||||||||
| LastUpdateDate: | 10/28/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/28/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 18319 | MS | N | Other Service Providers | Specialist | 2084P0800X | 18319 | MS | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0800X | ME97751 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 525093 | 01 | MS | VALUE OPTIONS | OTHER | 8708015 | 05 | MS | MEDICAID |