Provider Demographics
NPI:1770840829
Name:LAROSA, ANDREA L (FNP)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:L
Last Name:LAROSA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 IRIS LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-7540
Mailing Address - Country:US
Mailing Address - Phone:802-318-3323
Mailing Address - Fax:
Practice Address - Street 1:44 SOUTH MAIN STREET
Practice Address - Street 2:BOX 2000
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:802-728-2613
Is Sole Proprietor?:No
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT1010084543363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT047Z301Medicaid