Provider Demographics
NPI:1124570627
Name:CARYOTAKIS, CARISSA ALENA (NP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:ALENA
Last Name:CARYOTAKIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 HOWE AVE STE 455
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-1086
Mailing Address - Country:US
Mailing Address - Phone:916-454-2345
Mailing Address - Fax:
Practice Address - Street 1:3701 J ST STE 201
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5542
Practice Address - Country:US
Practice Address - Phone:855-354-2242
Practice Address - Fax:855-354-2242
Is Sole Proprietor?:No
Enumeration Date:2016-10-31
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00000363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner