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General NPI Number Information
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NPI Number | 1063818441
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Entity Type | Individual
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Provider Name | LARISA NERETINA NP
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Gender | Female
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 03/25/2022
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Provider Practice Location Address
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Address Line | 5220 W UNIVERSITY DR STE 250
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City | MCKINNEY
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State | TX
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Zip | 75071-7074
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Country | US
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Telephone | 469-800-5400
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Fax |
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Provider Business Mailing Address
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Address Line | 4325 N JOSEY LN 103
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City | CARROLLTON
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State | TX
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Zip | 75010-4635
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Country | US
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Telephone |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | AP126368
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | AP126368
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License Number State | TX
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