Provider Demographics
NPI:1134588429
Name:LARSON, ANNA BELEN (LM, CPM)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:BELEN
Last Name:LARSON
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:EVINSTON
Mailing Address - State:FL
Mailing Address - Zip Code:32633-0058
Mailing Address - Country:US
Mailing Address - Phone:352-591-3105
Mailing Address - Fax:
Practice Address - Street 1:18422 SOUTHEAST COUNTY ROAD 225
Practice Address - Street 2:
Practice Address - City:MICANOPY
Practice Address - State:FL
Practice Address - Zip Code:32667
Practice Address - Country:US
Practice Address - Phone:352-591-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2016-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL322176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife