Healthcare Provider Details

I. General information

NPI: 1174481188
Provider Name (Legal Business Name): CARISSA WISE FLOYD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1204 E CHEVES ST
FLORENCE SC
29506-2710
US

IV. Provider business mailing address

608 E MAIN ST
LAKE CITY SC
29560-2228
US

V. Phone/Fax

Practice location:
  • Phone: 853-673-0122
  • Fax:
Mailing address:
  • Phone: 843-673-0122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number32154
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: