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General NPI Number Information
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NPI Number | 1437561156
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Entity Type | Individual
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Provider Name | CAROL A CASANOVA RD
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Gender | Female
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Dates
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Enumeration Date | 05/29/2014
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Last Update Date | 05/29/2014
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Provider Practice Location Address
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Address Line | 3855 S. US HIGHWAY 1 SUITE B
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City | FORT PIERCE
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State | FL
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Zip | 34982
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Country | US
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Telephone | 772-344-2541
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Fax | 772-344-2544
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Provider Business Mailing Address
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Address Line | 5150 NORTHWEST MILNER DRIVE
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City | PORT ST LUCIE
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State | FL
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Zip | 34983
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | ND1513
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License Number State | FL
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