Provider Demographics
NPI:1992092878
Name:ANDERSON, ELICIA LARSHNEY
Entity type:Individual
Prefix:
First Name:ELICIA
Middle Name:LARSHNEY
Last Name:ANDERSON
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 1:22 BERMUDA GREENS AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-4370
Mailing Address - Country:US
Mailing Address - Phone:904-235-9722
Mailing Address - Fax:
Practice Address - Street 1:22 BERMUDA GREENS AVE
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-4370
Practice Address - Country:US
Practice Address - Phone:904-235-9722
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-29
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist