Provider Demographics
NPI:1679562136
Name:BANKS, CASONDRA A (PA-C)
Entity Type:Individual
Prefix:
First Name:CASONDRA
Middle Name:A
Last Name:BANKS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASONDRA
Other - Middle Name:A
Other - Last Name:BANKS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:801 YORK ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-4630
Mailing Address - Country:US
Mailing Address - Phone:920-663-9008
Mailing Address - Fax:920-684-1439
Practice Address - Street 1:530 FONTAINE ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2019
Practice Address - Country:US
Practice Address - Phone:800-243-7546
Practice Address - Fax:850-484-8223
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA3278363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P03330Medicare UPIN
P03330Medicare UPIN
FLE 3888ZMedicare ID - Type Unspecified