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General NPI Number Information
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NPI Number | 1578815197
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Entity Type | Organization
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Legal Business Name | LINDA A. LAROCCO, FAMILY NURSE PRACTITIONER, PLLC
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Dates
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Enumeration Date | 10/05/2012
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Last Update Date | 10/05/2012
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Provider Practice Location Address
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Address Line | 59 BONIFACE DR
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City | PINE BUSH
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State | NY
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Zip | 12566-7011
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Country | US
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Telephone | 845-744-4499
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Fax |
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Provider Business Mailing Address
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Address Line | 59 BONIFACE DR PO BOX 1579
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City | PINE BUSH
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State | NY
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Zip | 12566-7011
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Country | US
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Telephone | 845-744-4499
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LINDA LAROCCO
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Credential | FNP
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Telephone | 845-744-4499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 337273
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License Number State | NY
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