Provider Demographics
NPI:1619699352
Name:LARSEN, JESSICA BROOKE (APRN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:BROOKE
Last Name:LARSEN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10707 66TH ST N STE B
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33782-2353
Mailing Address - Country:US
Mailing Address - Phone:727-826-0933
Mailing Address - Fax:727-350-3487
Practice Address - Street 1:10707 66TH ST N STE B
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33782-2353
Practice Address - Country:US
Practice Address - Phone:727-826-0933
Practice Address - Fax:727-350-3487
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020087363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily