Provider Demographics
NPI:1366878357
Name:FRONK, CARISSA LYNNE (PA-C)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:LYNNE
Last Name:FRONK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:LYNNE
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-4914
Mailing Address - Country:US
Mailing Address - Phone:813-474-9804
Mailing Address - Fax:
Practice Address - Street 1:203 N MARION ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-4914
Practice Address - Country:US
Practice Address - Phone:813-474-9804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-23
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016988-1363A00000X
UT10771325-1206363A00000X
FL9115435363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant