Provider Demographics
NPI:1053027755
Name:SORRELLS, KARISSA ROXANNE
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:ROXANNE
Last Name:SORRELLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 S HWY A1A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-3207
Mailing Address - Country:US
Mailing Address - Phone:321-446-1339
Mailing Address - Fax:
Practice Address - Street 1:5050 S HWY A1A
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-3207
Practice Address - Country:US
Practice Address - Phone:321-446-1339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program