Provider Demographics
NPI:1861931032
Name:LARSEN, JODI (ARNP)
Entity type:Individual
Prefix:MS
First Name:JODI
Middle Name:
Last Name:LARSEN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
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Mailing Address - Street 1:95 BULLDOG BLVD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-3332
Mailing Address - Country:US
Mailing Address - Phone:321-727-2990
Mailing Address - Fax:321-724-0455
Practice Address - Street 1:6100 MINTON RD NW
Practice Address - Street 2:STE 102
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1900
Practice Address - Country:US
Practice Address - Phone:321-724-1171
Practice Address - Fax:321-724-9024
Is Sole Proprietor?:No
Enumeration Date:2017-02-21
Last Update Date:2017-03-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLARNP9323212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily