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 2 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