Healthcare Provider Details

I. General information

NPI: 1841074705
Provider Name (Legal Business Name): CASEY GILLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

636 DEL PRADO BLVD S
CAPE CORAL FL
33990-2695
US

IV. Provider business mailing address

15905 NORTHRIDGE RD
PUNTA GORDA FL
33982-2598
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049339
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License NumberRN9590496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: