Provider Demographics
NPI:1093495459
Name:LANGFORD, CASEY RAY (APRN)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:RAY
Last Name:LANGFORD
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2675 WINKLER AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-9342
Mailing Address - Country:US
Mailing Address - Phone:239-458-3338
Mailing Address - Fax:239-458-0666
Practice Address - Street 1:1528 DEL PRADO BLVD S
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3798
Practice Address - Country:US
Practice Address - Phone:239-458-3338
Practice Address - Fax:239-458-0666
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11027632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily