Provider Demographics
NPI:1528738689
Name:BARCO, LARA CAMILLE (FNP)
Entity type:Individual
Prefix:MRS
First Name:LARA
Middle Name:CAMILLE
Last Name:BARCO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:LARA
Other - Middle Name:CAMILLE
Other - Last Name:VERHULST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 KINGS HWY S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14617-5504
Mailing Address - Country:US
Mailing Address - Phone:585-865-8210
Mailing Address - Fax:585-865-7597
Practice Address - Street 1:2655 RIDGEWAY AVE STE 480
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4296
Practice Address - Country:US
Practice Address - Phone:585-865-8210
Practice Address - Fax:585-865-7597
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY347821363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily