Provider Demographics
NPI:1114919164
Name:LAROCCO, LINDA A (DNP, ANP-BC, FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:A
Last Name:LAROCCO
Suffix:
Gender:F
Credentials:DNP, ANP-BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BONIFACE DR
Mailing Address - Street 2:
Mailing Address - City:PINE BUSH
Mailing Address - State:NY
Mailing Address - Zip Code:12566-2977
Mailing Address - Country:US
Mailing Address - Phone:845-744-4499
Mailing Address - Fax:845-744-4497
Practice Address - Street 1:59 BONIFACE DR
Practice Address - Street 2:
Practice Address - City:PINE BUSH
Practice Address - State:NY
Practice Address - Zip Code:12566-2977
Practice Address - Country:US
Practice Address - Phone:845-744-4499
Practice Address - Fax:845-744-4497
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-16
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF-302800-1363LA2200X
NY337273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02391335Medicaid
NYA300000438Medicare PIN