Provider Demographics
NPI:1124873534
Name:LAROSE, SNARDY MERCIER
Entity type:Individual
Prefix:
First Name:SNARDY
Middle Name:MERCIER
Last Name:LAROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-3621
Mailing Address - Country:US
Mailing Address - Phone:305-519-3114
Mailing Address - Fax:
Practice Address - Street 1:2321 ARCADIA DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-3621
Practice Address - Country:US
Practice Address - Phone:130-551-9311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-19
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2139-P.A.363A00000X
FL24336895106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant