Provider Demographics
NPI:1104588995
Name:CARRANZA, NICHOLAUS PIERCE (PA-C)
Entity type:Individual
Prefix:
First Name:NICHOLAUS
Middle Name:PIERCE
Last Name:CARRANZA
Suffix:
Gender:M
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 1:134 ECKSTEIN LN
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:PA
Mailing Address - Zip Code:16037-8826
Mailing Address - Country:US
Mailing Address - Phone:814-207-1128
Mailing Address - Fax:
Practice Address - Street 1:2 W CRESCENT PARK
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2199
Practice Address - Country:US
Practice Address - Phone:814-723-4973
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOA005790363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical