Provider Demographics
NPI:1134676828
Name:LEFFINGWELL, LARISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:LEFFINGWELL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5988
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00823-5988
Mailing Address - Country:US
Mailing Address - Phone:340-713-7000
Mailing Address - Fax:
Practice Address - Street 1:4100 SION FARM SHOPP CTR
Practice Address - Street 2:5
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820-4433
Practice Address - Country:US
Practice Address - Phone:340-713-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI065363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical