Individual
LARISSA CONNELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
2376 CYPRESS CIRCLE, STE 102, CONWAY, SC 29526-8964
(843) 347-8953
(843) 347-0226
Mailing address
300 SINGLETON RIDGE RD, ATTENTION PNS CREDENTIALING, CONWAY, SC 29526-9142
(843) 234-6946
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18566
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
NP8763
—
SC
Enumeration date
11/01/2013
Last updated
04/02/2024
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