Healthcare Provider Details

I. General information

NPI: 1124377270
Provider Name (Legal Business Name): CARISSA LEIGH STROUSE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARISSA LEIGH REYES RN

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7404 5TH AVE
BROOKLYN NY
11209-2704
US

IV. Provider business mailing address

13280 EVENING CREEK DR S STE 225
SAN DIEGO CA
92128-4664
US

V. Phone/Fax

Practice location:
  • Phone: 877-658-2244
  • Fax: 858-724-6662
Mailing address:
  • Phone: 877-658-2244
  • Fax: 858-724-6662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11002979
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9270473
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number599181
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: