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 1:6101 BLUE LAGOON DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-3168
Mailing Address - Country:US
Mailing Address - Phone:305-500-2000
Mailing Address - Fax:
Practice Address - Street 1:2812 SAINT MARKS DR
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-1926
Practice Address - Country:US
Practice Address - Phone:727-328-4633
Practice Address - Fax:727-726-0529
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME125895207R00000X, 207R00000X
PR16593207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104860700Medicaid