Provider Demographics
NPI:1104260561
Name:PERINE, CARISSA (RN)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:
Last Name:PERINE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 ROCK HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:WALESKA
Mailing Address - State:GA
Mailing Address - Zip Code:30183-2525
Mailing Address - Country:US
Mailing Address - Phone:440-231-0373
Mailing Address - Fax:
Practice Address - Street 1:477 ROCK HOUSE RD
Practice Address - Street 2:
Practice Address - City:WALESKA
Practice Address - State:GA
Practice Address - Zip Code:30183-2525
Practice Address - Country:US
Practice Address - Phone:440-231-0373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH380929163WC0200X
GARN280964363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine