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General NPI Number Information
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NPI Number | 1033930607
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Entity Type | Individual
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Provider Name | BIANCA MICHELLE LARSH PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/17/2024
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Last Update Date | 03/27/2025
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Provider Practice Location Address
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Address Line | 2501 N ORANGE AVE STE 381
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City | ORLANDO
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State | FL
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Zip | 32804-4623
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Country | US
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Telephone | 407-609-9076
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Fax | 407-609-9077
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Provider Business Mailing Address
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Address Line | 16512 LAKE HEATHER DR
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City | TAMPA
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State | FL
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Zip | 33618-1165
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Country | US
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Telephone | 786-417-9542
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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