Provider Demographics
NPI:1376320119
Name:DENOSE-BLANCHETTE, LAROSE
Entity Type:Individual
Prefix:
First Name:LAROSE
Middle Name:
Last Name:DENOSE-BLANCHETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10142 NW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-6525
Mailing Address - Country:US
Mailing Address - Phone:678-468-2282
Mailing Address - Fax:
Practice Address - Street 1:10142 NW 16TH ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-6525
Practice Address - Country:US
Practice Address - Phone:678-468-2282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027245363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily