Individual
LARISSA NICOLE ANTHONY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2550 W UNION HILLS DR STE 390, PHOENIX, AZ 85027-5197
(602) 443-4068
(623) 434-8310
Mailing address
5151 E BROADWAY RD STE 107, MESA, AZ 85206-1346
(480) 290-7000
(602) 254-6840
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4993
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
339667
—
AZ
Enumeration date
09/28/2011
Last updated
03/17/2026
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