Healthcare Provider Details

I. General information

NPI: 1114919164
Provider Name (Legal Business Name): LINDA A LAROCCO DNP, ANP-BC, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 08/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 BONIFACE DR
PINE BUSH NY
12566-2977
US

IV. Provider business mailing address

59 BONIFACE DR
PINE BUSH NY
12566-2977
US

V. Phone/Fax

Practice location:
  • Phone: 845-744-4499
  • Fax: 845-744-4497
Mailing address:
  • Phone: 845-744-4499
  • Fax: 845-744-4497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF-302800-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337273
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: