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General NPI Number Information
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NPI Number | 1730632308
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Entity Type | Individual
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Provider Name | LARISSA CAPUTO
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Gender | Female
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Dates
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Enumeration Date | 07/29/2016
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Last Update Date | 02/20/2017
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Provider Practice Location Address
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Address Line | 1000 MAR WALT DR
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-6708
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Country | US
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Telephone | 850-862-1111
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Fax |
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Provider Business Mailing Address
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Address Line | 1860 SEAHAWK LN
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City | NAVARRE
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State | FL
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Zip | 32566-8530
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Country | US
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Telephone | 727-470-7950
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | RN9344203
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License Number State | FL
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