Provider Demographics
NPI:1124377270
Name:STROUSE, CARISSA LEIGH (APRN)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:LEIGH
Last Name:STROUSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:LEIGH
Other - Last Name:REYES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:7404 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-2704
Mailing Address - Country:US
Mailing Address - Phone:718-439-5111
Mailing Address - Fax:
Practice Address - Street 1:7404 5TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-2704
Practice Address - Country:US
Practice Address - Phone:718-439-5111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9270473163W00000X
NY599181163WG0000X
FL11002979363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice