Provider Demographics
NPI:1124358015
Name:CARMICHAEL, LARISSA (AP/DOM)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:CARMICHAEL
Suffix:
Gender:F
Credentials:AP/DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6981 CURTISS AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34231-8111
Mailing Address - Country:US
Mailing Address - Phone:941-724-5109
Mailing Address - Fax:
Practice Address - Street 1:6981 CURTISS AVE STE 3
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-8111
Practice Address - Country:US
Practice Address - Phone:941-724-5109
Practice Address - Fax:941-927-6937
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-28
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP1209171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist