Provider Demographics
NPI:1801081344
Name:CASADY, NICOLE ELIZABETH RATAJ (PA-C)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:ELIZABETH RATAJ
Last Name:CASADY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:ELIZABETH
Other - Last Name:RATAJ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 SOUTHHALL LN
Mailing Address - Street 2:STE 300
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7176
Mailing Address - Country:US
Mailing Address - Phone:407-875-2080
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:4170 CEDAR BLUFF DR
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-7627
Practice Address - Country:US
Practice Address - Phone:231-487-2230
Practice Address - Fax:231-487-6172
Is Sole Proprietor?:No
Enumeration Date:2007-09-07
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical