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General NPI Number Information
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NPI Number | 1093099855
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Entity Type | Individual
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Provider Name | LARISSA NICOLE ANTHONY PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2011
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2550 W UNION HILLS DR STE 390
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City | PHOENIX
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State | AZ
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Zip | 85027-5197
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Country | US
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Telephone | 602-443-4068
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Fax | 623-434-8310
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Provider Business Mailing Address
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Address Line | 5151 E BROADWAY RD STE 107
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City | MESA
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State | AZ
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Zip | 85206-1346
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Country | US
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Telephone | 480-290-7000
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Fax | 602-254-6840
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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 | 4993
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License Number State | AZ
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