Provider Demographics
NPI:1205379963
Name:MADRID, CARISSA (FNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:MADRID
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2529 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-5466
Mailing Address - Country:US
Mailing Address - Phone:512-978-9500
Mailing Address - Fax:
Practice Address - Street 1:2529 S 1ST ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-5466
Practice Address - Country:US
Practice Address - Phone:512-978-9500
Practice Address - Fax:512-901-9708
Is Sole Proprietor?:No
Enumeration Date:2016-11-29
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132633363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily