Provider Demographics
NPI:1730991092
Name:FRANCIS, LARISSA (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:
First Name:LARISSA
Middle Name:
Last Name:FRANCIS
Suffix:
Gender:F
Credentials:REGISTERED DIETITIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 SOUTHHALL LN STE 175
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7486
Mailing Address - Country:US
Mailing Address - Phone:407-551-3396
Mailing Address - Fax:
Practice Address - Street 1:3584 EDITH AVE
Practice Address - Street 2:
Practice Address - City:ENUMCLAW
Practice Address - State:WA
Practice Address - Zip Code:98022-5098
Practice Address - Country:US
Practice Address - Phone:630-881-2883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-23
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT91611133V00000X
CT002726133V00000X
IL164.011331133V00000X
FLTPND586133V00000X
WADI61488716133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered