Provider Demographics
NPI:1891985198
Name:CASANOVA FELIX, GWENDOLYN M (MD)
Entity Type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:M
Last Name:CASANOVA FELIX
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 1:7800 66TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-2101
Mailing Address - Country:US
Mailing Address - Phone:727-546-5702
Mailing Address - Fax:727-546-5700
Practice Address - Street 1:7800 66TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:PINELLAS PARK
Practice Address - State:FL
Practice Address - Zip Code:33781-2101
Practice Address - Country:US
Practice Address - Phone:727-546-5702
Practice Address - Fax:727-546-5700
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16593208D00000X, 207R00000X
FLME125895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104860700Medicaid