Individual
TARA NICOLE CARLESCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
821 N MAIN STREET EXT STE 210, WALLINGFORD, CT 06492-2464
(203) 294-3610
Mailing address
10321 TOWN WALK DR # 10321, HAMDEN, CT 06518-3721
(315) 430-4042
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
4160
CT
Other
Enumeration date
07/13/2018
Last updated
07/13/2018
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