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General NPI Number Information
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NPI Number | 1114266160
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Entity Type | Individual
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Provider Name | COURTNEY C LARSON CRNA, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 02/12/2013
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 4855 WINDWARD PKWY STE 200
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City | MILTON
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State | GA
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Zip | 30004-8609
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Country | US
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Telephone | 770-840-5502
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 ATWOOD DR
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City | CUMMING
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State | GA
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Zip | 30040-3068
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Country | US
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Telephone | 770-823-2937
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN202447
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN202447
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License Number State | GA
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