Provider Demographics
NPI:1831148907
Name:CASERTA, FILISSA M (CRNP)
Entity type:Individual
Prefix:
First Name:FILISSA
Middle Name:M
Last Name:CASERTA
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9106 PHILADELPHIA RD STE 108
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4335
Mailing Address - Country:US
Mailing Address - Phone:410-682-5040
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD STE 108
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4335
Practice Address - Country:US
Practice Address - Phone:410-682-5040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR096896363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403948300Medicaid
MDKR78H157Medicare ID - Type Unspecified
MDQ01387Medicare UPIN
MDKR79H158Medicare ID - Type Unspecified