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Individual

DR. ENA C CASANOVA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
3508 TAMIAMI TRL, SUITE C, PORT CHARLOTTE, FL 33952-8160
(941) 883-3313
(941) 883-3320
Mailing address
PO BOX 495790, PORT CHARLOTTE, FL 33949-5790
(941) 883-3313
(941) 883-3320

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME0052050
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
049113600
FL
01
07444
BC/BS FL INDIVIDUAL
FL
01
161629969
CORP TAX ID
FL
01
34749
BC/BS GROUP NUMBER
FL
01
5990509003
CIGNA
FL
Enumeration date
07/05/2005
Last updated
09/09/2020
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