Provider Demographics
NPI:1689187593
Name:CASANOVA, NICOLE MENARD (PA-C)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:MENARD
Last Name:CASANOVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:DESIREE
Other - Last Name:MENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 SUGAR CREEK CENTER BLVD STE 618
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3540
Mailing Address - Country:US
Mailing Address - Phone:832-655-4141
Mailing Address - Fax:713-457-5188
Practice Address - Street 1:1 SUGAR CREEK CENTER BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3560
Practice Address - Country:US
Practice Address - Phone:832-655-4141
Practice Address - Fax:713-457-5188
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA11488363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8JX267OtherBCBS - XCITE SURGICAL
TX8LH998OtherBCBS - BLUE STAR SURGICAL ASSISTANTS LLC
TXPA11488OtherTEXAS MEDICAL BOARD
TX8K1394OtherBCBS - UNIVERSAL SURGICAL PARTNERS
TX8KC170OtherBCBS - UNIVERSAL SURGICAL ASSISTANTS