Provider Demographics
NPI:1952336679
Name:STONE, CARISSA H (MD)
Entity Type:Individual
Prefix:
First Name:CARISSA
Middle Name:H
Last Name:STONE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:HEIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1988 GULF TO BAY BLVD
Mailing Address - Street 2:STE 1
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-3550
Mailing Address - Country:US
Mailing Address - Phone:727-953-8090
Mailing Address - Fax:
Practice Address - Street 1:2803 W SAINT ISABEL ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6343
Practice Address - Country:US
Practice Address - Phone:813-253-2273
Practice Address - Fax:813-253-2279
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83895208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266734700Medicaid
FL27936YMedicare ID - Type Unspecified
FL266734700Medicaid