Individual
NICOLE KAY LARSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
9225 N 3RD ST STE 102, PHOENIX, AZ 85020-2455
(602) 362-2983
(480) 565-4552
Mailing address
9225 N 3RD ST STE 102, PHOENIX, AZ 85020-2455
(602) 362-2983
(480) 565-4552
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TAP11391
AZ
363LF0000X
Family Nurse Practitioner
Primary
AP11391
AZ
Other
Enumeration date
07/17/2018
Last updated
08/13/2020
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