Provider Demographics
NPI:1124560388
Name:PISTILLI, CARISSA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:PISTILLI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:MITTICA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11 WHITEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4627
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 LINWOOD AVE W
Practice Address - Street 2:SUITE 102
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-2355
Practice Address - Country:US
Practice Address - Phone:201-432-7837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00683900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily