Individual ProviderEmily C CiovaccoPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address14215 Ballantyne Corporate Pl, Suite 230, Charlotte, NC 28277-3670(704) 316-5000(704) 384-7680PECOS EnrollmentBased on the most recent information from CMS, provider Emily C Ciovacco does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 34 days ago.Profile DetailsProvider ID1891008652Provider TypeIndividualFull NameCiovacco, Emily CCredentialPA-CGenderFemaleSole ProprietorNoEnumeration Date7/22/2010Last Updated2/17/2017Contact InformationPractice LocationPractice Address14215 Ballantyne Corporate Pl, Suite 230, Charlotte, NC 28277-3670Phone(704) 316-5000Fax(704) 316-5010Mailing LocationMailing AddressPO Box 60447, Charlotte, NC 28260-0447Phone(704) 384-7680FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense0010-04419North CarolinaCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicense014096New YorkProvider IdentifiersIDDescriptionIssuerID1891008652DescriptionMedicaidIssuerUnlistedNew YorkID1891008652DescriptionMedicaidIssuerUnlistedNorth CarolinaID1710PADescriptionMedicaidIssuerUnlistedSouth Carolina