Basic Information
| Provider Information | |||||||||
| NPI: | 1003276361 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PARISO | ||||||||
| FirstName: | COURTNEY | ||||||||
| MiddleName: | |||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | 8139777631 | ||||||||
| Practice Location | |||||||||
| Address1: | 3010 E 138TH AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336133904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8139752800 | ||||||||
| FaxNumber: | 8139777631 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2016 | ||||||||
| LastUpdateDate: | 03/01/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | ARNP9299260 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.