Basic Information
Provider Information
NPI: 1932122801
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: CASEY
FirstName: LINDA
MiddleName: CAROL
NamePrefix:  
NameSuffix:  
Credential: A.R.N.P.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3402 SAM ALLEN OAKS CIR
Address2:  
City: PLANT CITY
State: FL
PostalCode: 335655598
CountryCode: US
TelephoneNumber: 8139722000
FaxNumber: 8139785805
Practice Location
Address1: 13000 BRUCE B DOWNS BLVD
Address2:  
City: TAMPA
State: FL
PostalCode: 336124745
CountryCode: US
TelephoneNumber: 8139722000
FaxNumber: 8139785805
Other Information
ProviderEnumerationDate: 07/25/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X857072FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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