Healthcare Provider Details

I. General information

NPI: 1396306213
Provider Name (Legal Business Name): ANNA LAROCCA APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CAROLYN LN
CONWAY AR
72034-5015
US

IV. Provider business mailing address

955 CAROLYN LN
CONWAY AR
72034-5015
US

V. Phone/Fax

Practice location:
  • Phone: 501-327-2444
  • Fax: 501-327-2443
Mailing address:
  • Phone: 501-327-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA005803
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: