Provider Demographics
NPI:1306235825
Name:LARSEN, CARRIE (FNP -BC)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:FNP -BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75-5751 KUAKINI HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-1753
Mailing Address - Country:US
Mailing Address - Phone:808-333-3600
Mailing Address - Fax:
Practice Address - Street 1:95-5583 MAMALAHOA HWY.
Practice Address - Street 2:
Practice Address - City:NAALEHU
Practice Address - State:HI
Practice Address - Zip Code:96772
Practice Address - Country:US
Practice Address - Phone:808-333-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-21
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001883363LF0000X
HI4078-0363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily