Provider Demographics
NPI:1013381631
Name:TINGSTROM, CASEY (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:
Last Name:TINGSTROM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5712 WHISPERING WOODS DR
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8352
Mailing Address - Country:US
Mailing Address - Phone:850-420-3246
Mailing Address - Fax:
Practice Address - Street 1:5712 WHISPERING WOODS DR
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8352
Practice Address - Country:US
Practice Address - Phone:850-420-3246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9309434363LF0000X
FLARNP 9309434363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLIN260ZMedicare PIN