Healthcare Provider Details

I. General information

NPI: 1053844811
Provider Name (Legal Business Name): MRS. LARISSA FLORES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2017
Last Update Date: 12/27/2024
Certification Date: 12/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W CLARENDON AVE STE 200
PHOENIX AZ
85013-3422
US

IV. Provider business mailing address

300 W CLARENDON AVE STE 200
PHOENIX AZ
85013-3422
US

V. Phone/Fax

Practice location:
  • Phone: 602-776-0776
  • Fax: 602-705-0567
Mailing address:
  • Phone: 602-776-0776
  • Fax: 602-705-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP9917
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberAP9917
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: