Provider Demographics
NPI:1376635581
Name:BRIDDLE, CARISSA DAWN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:DAWN
Last Name:BRIDDLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 W BASELINE RD STE 140
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1065
Mailing Address - Country:US
Mailing Address - Phone:602-777-6000
Mailing Address - Fax:602-438-6550
Practice Address - Street 1:2720 W BASELINE RD # 140
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85283-1065
Practice Address - Country:US
Practice Address - Phone:602-777-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7043363AM0700X, 363AM0700X
WY312363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical