Healthcare Provider Details

I. General information

NPI: 1982515136
Provider Name (Legal Business Name): SENAH NOELLE LARSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 MALABAR RD NE STE 201
PALM BAY FL
32907-2559
US

IV. Provider business mailing address

2392 OKALANI ST
MELBOURNE FL
32940-7300
US

V. Phone/Fax

Practice location:
  • Phone: 321-407-7097
  • Fax: 321-600-2012
Mailing address:
  • Phone: 321-890-3862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: