Provider Demographics
NPI:1154874790
Name:NORIEGA, CARISSA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:CARISSA
Middle Name:
Last Name:NORIEGA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:MRS
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:NORIEGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10238 E HAMPTON AVE
Mailing Address - Street 2:#507
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3316
Mailing Address - Country:US
Mailing Address - Phone:480-821-3616
Mailing Address - Fax:
Practice Address - Street 1:10238 E HAMPTON AVE
Practice Address - Street 2:#507
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3316
Practice Address - Country:US
Practice Address - Phone:480-821-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-01
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8877363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner