Provider Demographics
NPI:1588398150
Name:HAFNER, LARISSA YVETTE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:LARISSA
Middle Name:YVETTE
Last Name:HAFNER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11829 BRICEWOOD PASS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4569
Mailing Address - Country:US
Mailing Address - Phone:210-621-3809
Mailing Address - Fax:
Practice Address - Street 1:11829 BRICEWOOD PASS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4569
Practice Address - Country:US
Practice Address - Phone:210-621-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1087143363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily