Doctor Name: | MARIANNE LARSEN |
NPI Number: | 1043350093 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | 0003034 |
Business Practice Address: | 4225 Nw American Ln Lake City, FL - 320554881 |
Business Phone Number: | 3867586141 |
Business Fax Number: | |
Mailing Address: | 1007 Pine Ave Sw, LIVE OAK |
State: | FL |
Postal Code: | 320644021 |
Phone Number: | 3863627822 |
Fax Number: | |
NPI Enumeration Date: | 02/07/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | 0003034 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | FL |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |