Provider Demographics
NPI:1598524977
Name:MAZAK, KADEN LARSEN (LPN)
Entity Type:Individual
Prefix:
First Name:KADEN
Middle Name:LARSEN
Last Name:MAZAK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 MASON ST
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-6309
Mailing Address - Country:US
Mailing Address - Phone:407-443-7403
Mailing Address - Fax:
Practice Address - Street 1:283 CRANES ROOST BLVD STE 111
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3437
Practice Address - Country:US
Practice Address - Phone:407-443-7403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171400000X, 374J00000X
FLPN5258037164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No171400000XOther Service ProvidersHealth & Wellness Coach
No374J00000XNursing Service Related ProvidersDoula