Provider Demographics
NPI:1942743471
Name:PELZEL, CARISSA (FNP)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:PELZEL
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:SEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:121 DEKALB AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-5493
Mailing Address - Country:US
Mailing Address - Phone:718-250-6534
Mailing Address - Fax:718-250-6567
Practice Address - Street 1:121 DEKALB AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5493
Practice Address - Country:US
Practice Address - Phone:718-250-6534
Practice Address - Fax:718-250-6553
Is Sole Proprietor?:No
Enumeration Date:2016-12-01
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP4919363LF0000X
NY346556363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily