Provider Demographics
NPI:1780154039
Name:CIARRICCO, CIARRA (PA-C)
Entity type:Individual
Prefix:
First Name:CIARRA
Middle Name:
Last Name:CIARRICCO
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 1:68 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:NJ
Mailing Address - Zip Code:08241-9768
Mailing Address - Country:US
Mailing Address - Phone:609-923-8157
Mailing Address - Fax:
Practice Address - Street 1:1601 TILTON RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08225-1877
Practice Address - Country:US
Practice Address - Phone:609-923-8157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-29
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00494600363A00000X, 363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical