Provider Demographics
NPI:1104226547
Name:GOLIK, VINCENT (FNP-C)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:GOLIK
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:IRWIN
Mailing Address - State:PA
Mailing Address - Zip Code:15642-3683
Mailing Address - Country:US
Mailing Address - Phone:724-864-9595
Mailing Address - Fax:
Practice Address - Street 1:905 SPRUCE ST STE 201
Practice Address - Street 2:
Practice Address - City:IRWIN
Practice Address - State:PA
Practice Address - Zip Code:15642-3683
Practice Address - Country:US
Practice Address - Phone:724-864-9595
Practice Address - Fax:724-864-9860
Is Sole Proprietor?:No
Enumeration Date:2014-09-03
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP014053363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032892830001Medicaid
CA3219OtherMEDICARE
PA1032892830002Medicaid