MEDICARE: LINDA A LAROCCO DNP, ANP-BC, 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	363LA2200X	Adult Health Nurse Practitioner	F-302800-1	NY
2	363LF0000X	Family Nurse Practitioner	337273	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114919164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA A LAROCCO DNP, ANP-BC, FNP

Provider Business Mailing Address
First Line	:	59 BONIFACE DR
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-2977
Country	:	US
Telephone Number	:	845-744-4499
Fax Number	:	845-744-4497

Provider Business Practice Location Address
First Line	:	59 BONIFACE DR
Second Line	:
City	:	PINE BUSH
State	:	NY
Zip	:	12566-2977
Country	:	US
Telephone Number	:	845-744-4499
Fax Number	:	845-744-4497

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	08/02/2012

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