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General NPI Number Information
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NPI Number | 1285284992
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Entity Type | Individual
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Provider Name | LARISSA JEROMINOW
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Gender | Female
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Dates
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Enumeration Date | 09/14/2019
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Last Update Date | 07/29/2025
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Provider Practice Location Address
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Address Line | 3611 14TH AVE STE 550
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City | BROOKLYN
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State | NY
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Zip | 11218-3773
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Country | US
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Telephone | 718-819-6144
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Fax | 718-819-6145
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Provider Business Mailing Address
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Address Line | 926 MAIN ST
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City | NASHVILLE
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State | TN
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Zip | 37206-3614
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Country | US
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Telephone | 615-436-9060
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Fax | 615-235-9725
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | F30911-01
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License Number State | NY
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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 | F309311-01
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License Number State | NY
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