Provider Demographics
NPI:1427746254
Name:LENDZEMO, LARISSA
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:LENDZEMO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11026 TAEDA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-7011
Mailing Address - Country:US
Mailing Address - Phone:407-749-1213
Mailing Address - Fax:
Practice Address - Street 1:11026 TAEDA DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-7011
Practice Address - Country:US
Practice Address - Phone:407-749-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-28
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL299995785163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health