Provider Demographics
NPI:1992549471
Name:CORRARO, CARISSA ANN (APRN)
Entity type:Individual
Prefix:
First Name:CARISSA
Middle Name:ANN
Last Name:CORRARO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 N BENHAM RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2247
Mailing Address - Country:US
Mailing Address - Phone:203-954-9054
Mailing Address - Fax:
Practice Address - Street 1:900 MAIN ST S STE 100
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4213
Practice Address - Country:US
Practice Address - Phone:203-954-9054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-20
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12.013357363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner