1447257548 NPI number — DR. ENA C CASANOVA M.D.

Table of content: DR. ENA C CASANOVA M.D. (NPI 1447257548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447257548 NPI number — DR. ENA C CASANOVA M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CASANOVA
Provider First Name:
ENA
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447257548
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 495790
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT CHARLOTTE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33949-5790
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-883-3313
Provider Business Mailing Address Fax Number:
941-883-3320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3508 TAMIAMI TRL
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
PORT CHARLOTTE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33952-8160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-883-3313
Provider Business Practice Location Address Fax Number:
941-883-3320
Provider Enumeration Date:
07/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  ME0052050 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 161629969 . This is a "CORP TAX ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 07444 . This is a "BC/BS FL INDIVIDUAL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 34749 . This is a "BC/BS GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5990509003 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 049113600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101885200 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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