Healthcare Provider Details

I. General information

NPI: 1598524977
Provider Name (Legal Business Name): KADEN LARSEN MAZAK LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 CRANES ROOST BLVD STE 111
ALTAMONTE SPRINGS FL
32701-3437
US

IV. Provider business mailing address

523 MASON ST
ALTAMONTE SPRINGS FL
32701-6309
US

V. Phone/Fax

Practice location:
  • Phone: 407-443-7403
  • Fax:
Mailing address:
  • Phone: 407-443-7403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberPN5258037
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: