MEDICARE: CARISSA LYNNE FRONK PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	016988-1	NY
2	363A00000X	Physician Assistant	10771325-1206	UT
3	363A00000X	Physician Assistant	9115435	FL

General Provider Information

NPI Number	:	1366878357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA LYNNE FRONK PA-C

Provider Business Mailing Address
First Line	:	203 N MARION ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4914
Country	:	US
Telephone Number	:	813-474-9804
Fax Number	:

Provider Business Practice Location Address
First Line	:	203 N MARION ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33602-4914
Country	:	US
Telephone Number	:	813-474-9804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/23/2013
Last Update Date	:	03/03/2025

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Directions to “ CARISSA LYNNE FRONK PA-C” Practice Location

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