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General NPI Number Information
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NPI Number | 1619306230
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Entity Type | Individual
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Provider Name | CARISSA TAROLI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/04/2013
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 189 E MARKET ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-5243
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Country | US
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Telephone | 570-846-2720
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Fax |
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Provider Business Mailing Address
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Address Line | 189 E MARKET ST
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City | WILKES BARRE
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State | PA
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Zip | 18702-5243
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 017175
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA058557
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License Number State | PA
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