Healthcare Provider Details

I. General information

NPI: 1790204329
Provider Name (Legal Business Name): JOSEPH MICHAEL PARRISH CAA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HICKORY ST
MELBOURNE FL
32901-3224
US

IV. Provider business mailing address

3216 SAND DUNES CT
MELBOURNE BEACH FL
32951-3001
US

V. Phone/Fax

Practice location:
  • Phone: 321-434-4700
  • Fax:
Mailing address:
  • Phone: 702-292-0315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA411
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number75000195A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: