Provider Demographics
NPI:1184448102
Name:LARRA-RAMIREZ, TERESA SOPHIA (LPN)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:SOPHIA
Last Name:LARRA-RAMIREZ
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:TERESA
Other - Middle Name:SOPHIA
Other - Last Name:ELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3784 NW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:OKEECHOBEE
Mailing Address - State:FL
Mailing Address - Zip Code:34972-2252
Mailing Address - Country:US
Mailing Address - Phone:863-447-8900
Mailing Address - Fax:
Practice Address - Street 1:3784 NW 1ST ST
Practice Address - Street 2:
Practice Address - City:OKEECHOBEE
Practice Address - State:FL
Practice Address - Zip Code:34972-2252
Practice Address - Country:US
Practice Address - Phone:863-447-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-15
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5264883164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse