Healthcare Provider Details

I. General information

NPI: 1134588429
Provider Name (Legal Business Name): ANNA BELEN LARSON LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2016
Last Update Date: 02/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18422 SOUTHEAST COUNTY ROAD 225
MICANOPY FL
32667
US

IV. Provider business mailing address

PO BOX 58
EVINSTON FL
32633-0058
US

V. Phone/Fax

Practice location:
  • Phone: 352-591-3105
  • Fax:
Mailing address:
  • Phone: 352-591-3105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: