Provider Demographics
NPI:1083171144
Name:VIZZA, PARISSA KIMIA (MSN, RN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:PARISSA
Middle Name:KIMIA
Last Name:VIZZA
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4611 US HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-8245
Mailing Address - Country:US
Mailing Address - Phone:904-264-4333
Mailing Address - Fax:
Practice Address - Street 1:4611 US HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-8245
Practice Address - Country:US
Practice Address - Phone:904-264-4333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-25
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95168487163W00000X
CA95011264363LP0200X
FLAPRN11038252363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163W00000XNursing Service ProvidersRegistered Nurse