Provider Demographics
NPI:1184490203
Name:CARACOLA, ALYSSA NICOLE (PA)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:NICOLE
Last Name:CARACOLA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:70 CENTERPORT RD
Mailing Address - Street 2:
Mailing Address - City:GREENLAWN
Mailing Address - State:NY
Mailing Address - Zip Code:11740-1020
Mailing Address - Country:US
Mailing Address - Phone:631-896-0031
Mailing Address - Fax:
Practice Address - Street 1:505 GRAND BLVD STE 1
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5300
Practice Address - Country:US
Practice Address - Phone:631-243-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-29
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant