Healthcare Provider Details

I. General information

NPI: 1790256170
Provider Name (Legal Business Name): LAURA A CASEY APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2018
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17179 BONNIE AVE UNIT C
PORT CHARLOTTE FL
33954-2715
US

IV. Provider business mailing address

17179 BONNIE AVE UNIT C
PORT CHARLOTTE FL
33954-2715
US

V. Phone/Fax

Practice location:
  • Phone: 941-228-4706
  • Fax: 234-901-6261
Mailing address:
  • Phone: 941-228-4706
  • Fax: 234-901-6261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9384259
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: