Provider Demographics
NPI:1427240100
Name:CROES, CASEY ROBERTS (PA-C)
Entity type:Individual
Prefix:MRS
First Name:CASEY
Middle Name:ROBERTS
Last Name:CROES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:EUGENIA
Other - Middle Name:CASE
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:151 SOUTHHALL LN STE 300
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-7172
Mailing Address - Country:US
Mailing Address - Phone:866-400-3376
Mailing Address - Fax:407-650-3455
Practice Address - Street 1:1507 PARK CENTER DR UNIT 1D1E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5795
Practice Address - Country:US
Practice Address - Phone:866-400-3376
Practice Address - Fax:407-293-3908
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MP00169300363A00000X
FLPA9114402363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ115439DF5Medicare PIN