Healthcare Provider Details

I. General information

NPI: 1568124584
Provider Name (Legal Business Name): EMINA SKOPLJAK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 08/09/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1779 5TH AVE
YORK PA
17403-2632
US

IV. Provider business mailing address

7104 CREEK CROSSING DR
HARRISBURG PA
17111-5087
US

V. Phone/Fax

Practice location:
  • Phone: 717-815-2700
  • Fax:
Mailing address:
  • Phone: 717-712-6751
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA063184
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: