Provider Demographics
NPI:1659930063
Name:JENSEN, LARRA (HCHI, HD)
Entity Type:Individual
Prefix:MRS
First Name:LARRA
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:HCHI, HD
Other - Prefix:
Other - First Name:LARRA
Other - Middle Name:
Other - Last Name:KINLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:501 DEGROODT RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-7420
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 DEGROODT RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32908-7420
Practice Address - Country:US
Practice Address - Phone:321-917-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-10
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula