Provider Demographics
NPI:1164729158
Name:LAROCK, JINNY JOY (RN, BCIAC)
Entity Type:Individual
Prefix:MS
First Name:JINNY
Middle Name:JOY
Last Name:LAROCK
Suffix:
Gender:F
Credentials:RN, BCIAC
Other - Prefix:MS
Other - First Name:VIRGINIA
Other - Middle Name:JOY
Other - Last Name:LAROCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:499 W BELLEVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-6701
Mailing Address - Country:US
Mailing Address - Phone:303-667-6048
Mailing Address - Fax:303-433-1899
Practice Address - Street 1:499 W BELLEVIEW AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-6701
Practice Address - Country:US
Practice Address - Phone:303-667-6048
Practice Address - Fax:303-433-1899
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39172163WP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0000XNursing Service ProvidersRegistered NursePain Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
11572944OtherCAQH