Provider Demographics
NPI:1023268505
Name:TKACHENKO, LISA M (PA-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:M
Last Name:TKACHENKO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:LISS
Other - Middle Name:M
Other - Last Name:YINGLING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08007-0159
Mailing Address - Country:US
Mailing Address - Phone:484-884-4500
Mailing Address - Fax:484-884-0699
Practice Address - Street 1:410 N KROCKS RD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18106-9283
Practice Address - Country:US
Practice Address - Phone:888-982-8594
Practice Address - Fax:888-920-1525
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053629363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical