Provider Demographics
NPI:1699381483
Name:CARROLL, CHARISSA (APRN)
Entity Type:Individual
Prefix:
First Name:CHARISSA
Middle Name:
Last Name:CARROLL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CHARISSA
Other - Middle Name:ELIZABETH
Other - Last Name:HOBBS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:936 BARCARMIL WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-0903
Mailing Address - Country:US
Mailing Address - Phone:239-265-3391
Mailing Address - Fax:239-310-2035
Practice Address - Street 1:936 BARCARMIL WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-0903
Practice Address - Country:US
Practice Address - Phone:239-265-3391
Practice Address - Fax:239-310-2035
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-17
Last Update Date:2023-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013240363LF0000X
FLAPRN9335745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily