Provider Demographics
NPI:1851599070
Name:CASERTA, DOUGLAS CHARLES (FNP-BC, CNP)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:CHARLES
Last Name:CASERTA
Suffix:
Gender:M
Credentials:FNP-BC, CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10053 EUPHEMIA CASTINE RD
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-9534
Mailing Address - Country:US
Mailing Address - Phone:937-670-2745
Mailing Address - Fax:
Practice Address - Street 1:5735 MEEKER RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-1186
Practice Address - Country:US
Practice Address - Phone:937-548-3806
Practice Address - Fax:937-548-2087
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.09311-NP363LA2100X
OHAPRN.CNP.09311363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NP-09311OtherLICENSE
OH2853676Medicaid
MC1588372OtherDEA
NP-09311OtherLICENSE