Provider Demographics
NPI:1538468715
Name:CASELNOVA, PETRA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:PETRA
Middle Name:MICHELLE
Last Name:CASELNOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 HEALING WAY STE 304
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-5453
Mailing Address - Country:US
Mailing Address - Phone:813-929-5341
Mailing Address - Fax:813-929-5393
Practice Address - Street 1:2700 HEALING WAY STE 304
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543
Practice Address - Country:US
Practice Address - Phone:813-929-5341
Practice Address - Fax:813-929-5393
Is Sole Proprietor?:No
Enumeration Date:2011-03-27
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 123987207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015038600Medicaid
FL015038600Medicaid