| Doctor Name: | MS. LARISSA NICOLE ANTHONY |
| NPI Number: | 1093099855 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA-C |
| License Number: | 4993 |
| Business Practice Address: | 10585 N Tatum Blvd Ste D130 Paradise Valley, AZ - 852531073 |
| Business Phone Number: | 6029977263 |
| Business Fax Number: | 6029444553 |
| Mailing Address: | 1112 E Mcdowell Rd, PHOENIX |
| State: | AZ |
| Postal Code: | 850062611 |
| Phone Number: | 6022584951 |
| Fax Number: | 6023401853 |
| NPI Enumeration Date: | 09/28/2011 |
| NPI Last Update Date: | 02/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 4993 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AZ |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |