Individual
EMILY C CIOVACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
14215 BALLANTYNE CORPORATE PL, SUITE 230, CHARLOTTE, NC 28277-3670
(704) 316-5000
(704) 316-5010
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(704) 384-7680
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-04419
NC
363A00000X
Physician Assistant
014096
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1710PA
—
SC
05
—
1891008652
—
NC
05
—
1891008652
—
NY
Enumeration date
07/22/2010
Last updated
02/17/2017
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