Provider Demographics
NPI:1871046698
Name:LARSEN, GUYRLA (RN)
Entity Type:Individual
Prefix:
First Name:GUYRLA
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3247 NW 123RD AVE
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3023
Mailing Address - Country:US
Mailing Address - Phone:715-754-7056
Mailing Address - Fax:
Practice Address - Street 1:3247 NW 123RD AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3023
Practice Address - Country:US
Practice Address - Phone:715-754-7056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2016-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9351993163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse