Individual
LARAE TYMOCHKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2315 MYRTLE ST STE 160, ERIE, PA 16502-4602
(814) 456-9197
(814) 455-2765
Mailing address
2315 MYRTLE ST STE 160, ERIE, PA 16502-4602
(814) 456-9197
(814) 455-2765
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA060474
PA
363AS0400X
Surgical Physician Assistant
50.005833RX
OH
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/05/2017
Last updated
04/04/2024
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