Provider Demographics
NPI:1184003725
Name:HANK, CARLY (PA-C)
Entity Type:Individual
Prefix:
First Name:CARLY
Middle Name:
Last Name:HANK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 601
Mailing Address - Street 2:TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-0601
Mailing Address - Country:US
Mailing Address - Phone:585-335-3416
Mailing Address - Fax:585-335-8695
Practice Address - Street 1:61 STATE STREET
Practice Address - Street 2:TRI-COUNTY FAMILY MEDICINE PROGRAM, INC.
Practice Address - City:NUNDA
Practice Address - State:NY
Practice Address - Zip Code:14517-0729
Practice Address - Country:US
Practice Address - Phone:585-468-2528
Practice Address - Fax:585-468-5424
Is Sole Proprietor?:No
Enumeration Date:2015-05-28
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018475363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant