Healthcare Provider Details

I. General information

NPI: 1831044346
Provider Name (Legal Business Name): MARC LAGROSA NURSE PRACTITIONER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 E CARACAS AVE
HERSHEY PA
17033-1207
US

IV. Provider business mailing address

1205 E CARACAS AVE
HERSHEY PA
17033-1207
US

V. Phone/Fax

Practice location:
  • Phone: 570-316-5969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP036508
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: