Provider Demographics
NPI:1932517034
Name:HERSCHELL, CASEY NICOLE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:NICOLE
Last Name:HERSCHELL
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13425 BELCHER RD S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33771-4009
Mailing Address - Country:US
Mailing Address - Phone:727-223-9610
Mailing Address - Fax:727-303-3193
Practice Address - Street 1:13425 BELCHER RD S
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771
Practice Address - Country:US
Practice Address - Phone:727-223-9610
Practice Address - Fax:727-303-3193
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-01
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9348259363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103678200Medicaid