Provider Demographics
NPI:1801148093
Name:SCHMIDT, LARISSA (DPM)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:SCHMIDT
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:LARISSA
Other - Middle Name:
Other - Last Name:MCDONOUGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:410 CELEBRATION PL
Mailing Address - Street 2:STE 206
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5434
Mailing Address - Country:US
Mailing Address - Phone:321-939-2001
Mailing Address - Fax:321-939-2006
Practice Address - Street 1:410 CELEBRATION PL
Practice Address - Street 2:STE 206
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5434
Practice Address - Country:US
Practice Address - Phone:321-939-2001
Practice Address - Fax:321-939-2006
Is Sole Proprietor?:No
Enumeration Date:2012-10-11
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPR 237213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery