Provider Demographics
NPI:1558411348
Name:CASERTA, ERIKA L (PAC)
Entity Type:Individual
Prefix:MRS
First Name:ERIKA
Middle Name:L
Last Name:CASERTA
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MRS
Other - First Name:ERIKA
Other - Middle Name:L
Other - Last Name:FAUCI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHYSICIAN ASSISTANT
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1450 MATTHEWS TOWNSHIP PKWY STE 380
Practice Address - Street 2:
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2389
Practice Address - Country:US
Practice Address - Phone:704-384-9200
Practice Address - Fax:704-384-6588
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103172363AM0700X
NC0010-07096363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1558411348Medicaid