Provider Demographics
NPI:1629354618
Name:SOLLER, CHARISSE (APRN)
Entity Type:Individual
Prefix:
First Name:CHARISSE
Middle Name:
Last Name:SOLLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11215 S IH 35
Mailing Address - Street 2:SUITE 114
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-1863
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13450 N HWY 183
Practice Address - Street 2:SUITE 115
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-3239
Practice Address - Country:US
Practice Address - Phone:512-609-8338
Practice Address - Fax:512-609-8344
Is Sole Proprietor?:No
Enumeration Date:2011-10-23
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736533364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health