Provider Demographics
NPI:1437843018
Name:YAGUDAYEVA, LARISA (FNP)
Entity Type:Individual
Prefix:MS
First Name:LARISA
Middle Name:
Last Name:YAGUDAYEVA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LARISA
Other - Middle Name:
Other - Last Name:YAGUDAYEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:425 NORTH AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-2646
Mailing Address - Country:US
Mailing Address - Phone:917-436-9451
Mailing Address - Fax:
Practice Address - Street 1:425 NORTH AVE APT 1
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-2646
Practice Address - Country:US
Practice Address - Phone:917-436-9451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF349121363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily