Healthcare Provider Details

I. General information

NPI: 1083259311
Provider Name (Legal Business Name): JOVITE A LARROY CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2019
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W BROADWAY STE E
FARMINGTON NM
87401-5638
US

IV. Provider business mailing address

1001 W BROADWAY STE DE
FARMINGTON NM
87401-5638
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-4796
  • Fax:
Mailing address:
  • Phone: 505-327-4796
  • Fax: 505-599-9351

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number60472
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: