Provider Demographics
NPI:1376614669
Name:SUMMA, CARISSA ANNE (DO)
Entity Type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:ANNE
Last Name:SUMMA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:599 9TH ST N STE 300
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34102-5624
Mailing Address - Country:US
Mailing Address - Phone:239-444-3376
Mailing Address - Fax:239-316-3001
Practice Address - Street 1:10200 ARCOS AVE STE 201
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3529
Practice Address - Country:US
Practice Address - Phone:239-390-3376
Practice Address - Fax:239-333-0474
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS17127207N00000X
FLOS9893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
37R221Medicare PIN