Provider Demographics
NPI:1467146209
Name:POLANCO, JOANNY (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANNY
Middle Name:
Last Name:POLANCO
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 1:27 HILL TOP ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02124-5809
Mailing Address - Country:US
Mailing Address - Phone:407-575-3295
Mailing Address - Fax:
Practice Address - Street 1:27 HILL TOP ST APT 1
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02124-5809
Practice Address - Country:US
Practice Address - Phone:407-575-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant