Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Carly Jo Hennek, PA-C

Individual provider Physician Assistant · NPI 1023824406

Carly Jo Hennek, PA-C is a Physician Assistant in Roseville, Minnesota. Qualified in 2024, 2 years ago. Practices with Tareen Dermatology PA, a 44-clinician group. Licensed in Minnesota.

Years since qualifying
2
Licensed in
MN
In the registry since
2024
What do these letters mean?
PA-C — Physician Assistant, Certified
A physician assistant who holds current national certification.

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Practice location Address checks out

2720 Fairview Ave N Ste 200
Roseville, MN 55113-1306
Phone: (651) 633-6883
Fax: (651) 331-3459
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 15246 (MN)

Record details

NPI number1023824406
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA-C
Sole proprietorNo
NPI enumeratedDecember 10, 2024
Last updated in NPPESFebruary 10, 2025
Certification dateFebruary 10, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2024 (2 years in practice)
Group practice Tareen Dermatology Pa — 44 clinicians
Accepts Medicare assignment Not indicated
Practice locations5 on file with Medicare

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