Provider Demographics
NPI:1033569355
Name:DEVLIN, CARISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:HILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 865095
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-5095
Mailing Address - Country:US
Mailing Address - Phone:786-624-5712
Mailing Address - Fax:305-668-5539
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155
Practice Address - Country:US
Practice Address - Phone:305-666-6511
Practice Address - Fax:305-662-8291
Is Sole Proprietor?:No
Enumeration Date:2016-06-17
Last Update Date:2019-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9111970363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant