Individual
MRS. CARISSA PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
109 W KNAPP AVE, EDGEWATER, FL 32132-1555
(386) 957-4100
(386) 957-4104
Mailing address
472 OLD MISSION RD, NEW SMYRNA BEACH, FL 32168-8552
(386) 314-7483
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
ARNP9249998
FL
363LG0600X
Gerontology Nurse Practitioner
ARNP9249998
FL
Other
Enumeration date
08/10/2016
Last updated
04/26/2022
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