Provider Demographics
NPI:1528586880
Name:TARTAGLIA, CARISSA LEIGH (ARNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:LEIGH
Last Name:TARTAGLIA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:LEIGH
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:9351 CORKSCREW RD STE 101
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-6801
Mailing Address - Country:US
Mailing Address - Phone:239-336-4182
Mailing Address - Fax:239-799-0890
Practice Address - Street 1:9351 CORKSCREW RD STE 101
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-6801
Practice Address - Country:US
Practice Address - Phone:239-336-4182
Practice Address - Fax:239-799-0890
Is Sole Proprietor?:No
Enumeration Date:2017-09-06
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9349322363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics