Healthcare Provider Details

I. General information

NPI: 1740819754
Provider Name (Legal Business Name): DEREK CASEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2020
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 SE 9TH ST STE 106
FORT LAUDERDALE FL
33316-1113
US

IV. Provider business mailing address

2633 NW 48TH ST
BOCA RATON FL
33434-2586
US

V. Phone/Fax

Practice location:
  • Phone: 549-463-0112
  • Fax: 954-463-0117
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberOS19961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: