Individual
CARISSA SIMONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
17 DAVIS BLVD, SUITE 308, TAMPA, FL 33606-3475
(813) 250-2506
Mailing address
17 DAVIS BLVD, SUITE 308, TAMPA, FL 33606-3475
(813) 250-2506
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
ME139925
FL
208M00000X
Hospitalist Physician
Primary
ME139925
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103273200
—
FL
01
—
9FMVO
BLUE CROSS BLUE SHIELD
FL
01
—
LH661
MEDICARE
FL
Enumeration date
03/24/2016
Last updated
07/17/2019
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