Individual
CHARLES PANKOW JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNP
Contact information
Practice address
330 SOUTH NINTH STREET, PHILADELPHIA, PA 19107-6103
(215) 662-3606
(215) 829-6606
Mailing address
330 SOUTH NINTH STREET, PHILADELPHIA, PA 19107-6103
(215) 662-3606
(215) 829-6606
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
SP034276
PA
363LA2100X
Acute Care Nurse Practitioner
APRN11033483
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122896600
—
FL
Enumeration date
06/18/2024
Last updated
02/18/2026
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