Provider Demographics
NPI:1154076776
Name:MILLER, CARISSA (AGNP-BC)
Entity Type:Individual
Prefix:MS
First Name:CARISSA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 W MACPHAIL RD STE 105&106
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4309
Mailing Address - Country:US
Mailing Address - Phone:410-638-8900
Mailing Address - Fax:410-638-8916
Practice Address - Street 1:615 W MACPHAIL RD STE 105&106
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-4309
Practice Address - Country:US
Practice Address - Phone:410-638-8900
Practice Address - Fax:410-638-8916
Is Sole Proprietor?:No
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR183678363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care