Healthcare Provider Details

I. General information

NPI: 1083171144
Provider Name (Legal Business Name): PARISSA KIMIA VIZZA MSN, RN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9337 ATLANTIC BLVD STE 8
JACKSONVILLE FL
32225-8218
US

IV. Provider business mailing address

13490 GRAN BAY PKWY UNIT 3
JACKSONVILLE FL
32258-7446
US

V. Phone/Fax

Practice location:
  • Phone: 904-780-2100
  • Fax: 844-612-3977
Mailing address:
  • Phone: 617-850-2465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95168487
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number95011264
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAPRN11038252
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: