Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME114053 | FL |
NPI | 1043483217 |
---|---|
Provider Name | Teresita Maria Casanova |
First Address | Greenacres, FL 33463-4727 |
Second Address | Atlantis, FL 33462 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2008 |
Last Update Date | 07/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
008828900 | (05) | FL |