Provider Demographics
NPI:1306414305
Name:CASIMIR, EDITH M
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:M
Last Name:CASIMIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2636 CADIZ ST
Mailing Address - Street 2:
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34286-6975
Mailing Address - Country:US
Mailing Address - Phone:941-250-9384
Mailing Address - Fax:941-429-2839
Practice Address - Street 1:2636 CADIZ ST
Practice Address - Street 2:
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34286-6975
Practice Address - Country:US
Practice Address - Phone:941-250-9384
Practice Address - Fax:941-429-2839
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-15
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide