MEDICARE: ELIZABETH ANN LARINO FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R24699	NM
2	363LF0000X	Family Nurse Practitioner	ARNP9260771	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34460	OTHER	FL	MEDICARE GROUP

General Provider Information

NPI Number	:	1053370445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH ANN LARINO FNP

Provider Business Mailing Address
First Line	:	6037 GANNETDALE DR
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-3891
Country	:	US
Telephone Number	:	813-661-8690
Fax Number	:

Provider Business Practice Location Address
First Line	:	13311 N 56TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33617-1161
Country	:	US
Telephone Number	:	813-899-2015
Fax Number	:	813-987-2700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2006
Last Update Date	:	06/10/2008

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