Healthcare Provider Details

I. General information

NPI: 1295664811
Provider Name (Legal Business Name): KATHYRIA CASANOVA FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224 SANTA BARBARA BLVD
CAPE CORAL FL
33991-2038
US

IV. Provider business mailing address

2615 51ST ST SW
LEHIGH ACRES FL
33976-4843
US

V. Phone/Fax

Practice location:
  • Phone: 239-424-1479
  • Fax: 239-343-4145
Mailing address:
  • Phone: 239-209-3989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberAPRN11048197
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: