Provider Demographics
NPI:1124001425
Name:LARSON, RACHELLE P (CRNA)
Entity type:Individual
Prefix:MRS
First Name:RACHELLE
Middle Name:P
Last Name:LARSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:RACHELLE
Other - Middle Name:LYNN
Other - Last Name:PLATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:7631 BROOK FOREST WAY
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-7804
Mailing Address - Country:US
Mailing Address - Phone:850-479-4384
Mailing Address - Fax:850-479-4384
Practice Address - Street 1:8333 N DAVIS HWY
Practice Address - Street 2:WEST FLORIDA MEDICAL CENTER CLINIC PA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-6050
Practice Address - Country:US
Practice Address - Phone:850-474-8688
Practice Address - Fax:850-969-2910
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2010-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1284012367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered