Provider Demographics
NPI:1396363412
Name:LARSON, SUZANNE PACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:PACE
Last Name:LARSON
Suffix:
Gender:F
Credentials:FNP-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 44
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:CO
Mailing Address - Zip Code:81151-0044
Mailing Address - Country:US
Mailing Address - Phone:719-580-5757
Mailing Address - Fax:
Practice Address - Street 1:21278 SADDLE MOUNTIAN DR
Practice Address - Street 2:
Practice Address - City:SANFORD,L
Practice Address - State:CO
Practice Address - Zip Code:81151-8115
Practice Address - Country:US
Practice Address - Phone:806-282-7094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995591-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily