JORDAN ELIZABETH EVANICKI (NPI# 1679974372) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679974372 |
| Entity Type | Individual |
| Full Name | JORDAN ELIZABETH EVANICKI |
| Credential | PA-C |
| Practice Address |
4901 Lac De Ville Blvd Clinton Crossings, Building D, Suite 120 Rochester NY 14618-5647 |
| Mailing Address |
8979 State Route 5 and 20 Bloomfield NY 14469-9537 |
| Practice Telephone | 5852755321 |
| Mailing Telephone | 5853137503 |
| Enumeration Date | 2014-09-12 |
| Last Update Date | 2015-12-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4901 LAC DE VILLE BLVD CLINTON CROSSINGS, BUILDING D, SUITE 120 |
| City | ROCHESTER |
| State | NY |
| Zip Code | 14618-5647 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144262551 | University Medical Imaging PC | Radiology | 4901 Lac De Ville Blvd, Suite 140, Rochester, NY 14618-5647 | 2006-06-11 |
| 1255932620 | Austin John Coppola | Physical Therapist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2020-11-03 |
| 1669072864 | Megan Bessel | Physician Assistant | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2020-10-27 |
| 1598364291 | Katherine E. Lamb | Nurse Practitioner | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2020-10-22 |
| 1295333961 | Rochelle Helvey | Specialist/Technologist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2020-10-14 |
| 1144838194 | Paige Elizabeth Harrington | Nurse Practitioner | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2020-07-15 |
| 1497393284 | Jake Keller | Physical Therapist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2019-12-12 |
| 1386281236 | Kristen Rebecca Petrushesky | Physical Therapist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2019-12-10 |
| 1952948028 | Caleb Miraglia | Physical Therapist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2019-12-07 |
| 1992342216 | Patrick Barber | Physical Therapist | 4901 Lac De Ville Blvd, Rochester, NY 14618-5647 | 2019-12-05 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962056499 | Zahavi Dental of Rochester | Dentist | 1815 S. Clinton Ave, 510, Rocheter, NY 14618 | 2019-08-01 |
| 1760047278 | Inner Power Physical Therapy Pllc | Clinic/Center | 2561 Lac Deville Boulevard, Suite 100, Rochester, NY 14618 | 2019-05-09 |
| 1659859858 | Steven Sanfilippo | Counselor | 2000 S. Winton Rd., Building 4, Suite 303, Rochester, NY 14618 | 2018-07-31 |
| 1578064853 | Feet First Inc | Durable Medical Equipment & Medical Supplies | 1900 Clinton Ave S Ste 5, Rochester, NY 14618 | 2018-02-22 |
| 1558805374 | Jennifer Virella | Social Worker | 2000 South Winton Road, Bldg 2, Rochester, NY 14618 | 2016-12-13 |
| 1235589300 | Andrew Cyrus Marcy | Nurse Practitioner | 95 Allens Creek Road Bld 1 Ste 306, Rochester, NY 14618 | 2016-06-20 |
| 1932561073 | Legacy Pediatrics | Pediatrics | 1815 South Clinton Avenue Ste 360, Rochester, NY 14618 | 2016-03-28 |
| 1790143105 | Marie Lynn Bieber | Dietitian, Registered | 919 Winton Rd S Ste 220, Rochester, NY 14618 | 2016-02-01 |
| 1720443096 | Brittany Rose Masetta | Marriage & Family Therapist | 2000 S Winton Rd, Bldg 4, Suite #200, Rochester, NY 14618 | 2015-12-30 |
| 1437543097 | Kathleen Skye Kemp | Internal Medicine | 2400 S Clinton Ave Ste G2, Rochester, NY 14618 | 2015-03-22 |
| Find all providers in zip 14618 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194340505 | Kayleigh Marie Tourt | Physician Assistant | 222 Alexander St Fl 4, Rochester, NY 14607-4039 | 2020-06-11 |
| 1659923704 | Colin J Montgomery | Physician Assistant | 2400 S Clinton Ave Bldg G2nd, Rochester, NY 14618-2668 | 2019-07-09 |
| 1184183592 | Jera Delibashi | Physician Assistant | 89 Genesee St Fl 3, Rochester, NY 14611-3201 | 2019-03-15 |
| 1255808309 | Lauren Leigh D'hont | Physician Assistant | 400 White Spruce Blvd Ste A, Rochester, NY 14623-1619 | 2018-10-26 |
| 1124547823 | Lucas Polito | Physician Assistant | 1724 East Ridge Road, Rochester, NY 14622 | 2017-09-13 |
| 1629523956 | Reggie Testa Cayetano | Physician Assistant | 601 Elmwood Ave Box 619-13, Rochester, NY 14642-0001 | 2016-08-16 |
| 1891248373 | Padma Priya Rathina Sabapathy | Physician Assistant | 1561 Long Pond Rd Ste 302, Rochester, NY 14626-4135 | 2016-08-01 |
| 1821407669 | Amy C Dvorak | Physician Assistant | 1425 Portland Ave # 306, Rochester, NY 14621-3001 | 2014-08-06 |
| 1154741742 | Amanda Buckner | Physician Assistant | 158 Sawgrass Dr, Floor 2, Rochester, NY 14620-4648 | 2014-04-22 |
| 1053749614 | Amy Desantis | Physician Assistant | 9 Merrydale Drive, Rochester, NY 14624 | 2013-10-17 |
| Find all providers in ROCHESTER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.