Individual
MS. NICOLE MENARD CASANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA11488
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8JX267
BCBS - XCITE SURGICAL
TX
01
—
8K1394
BCBS - UNIVERSAL SURGICAL PARTNERS
TX
01
—
8KC170
BCBS - UNIVERSAL SURGICAL ASSISTANTS
TX
01
—
8LH998
BCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TX
01
—
PA11488
TEXAS MEDICAL BOARD
TX
Enumeration date
11/14/2017
Last updated
07/26/2019
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