Provider Demographics
NPI:1972219160
Name:MARQUES, LARISSA GONCALVES DE TOLEDO (FNP)
Entity Type:Individual
Prefix:
First Name:LARISSA
Middle Name:GONCALVES DE TOLEDO
Last Name:MARQUES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1594 DAWNVIEW DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-6506
Mailing Address - Country:US
Mailing Address - Phone:510-258-1143
Mailing Address - Fax:
Practice Address - Street 1:1594 DAWNVIEW DR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-6506
Practice Address - Country:US
Practice Address - Phone:510-258-1143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-30
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95244698163W00000X
CA95029050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse