Healthcare Provider Details

I. General information

NPI: 1912819319
Provider Name (Legal Business Name): NEISA MARIE CARSELE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5860 RANCH LAKE BLVD STE 200
LAKEWOOD RANCH FL
34202-3719
US

IV. Provider business mailing address

930 1ST AVE N UNIT 607
ST PETERSBURG FL
33705-1725
US

V. Phone/Fax

Practice location:
  • Phone: 941-388-8997
  • Fax:
Mailing address:
  • Phone: 724-971-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: