Provider Demographics
NPI:1992125264
Name:PARKER, CASIE J (PA-C)
Entity type:Individual
Prefix:
First Name:CASIE
Middle Name:J
Last Name:PARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 7TH STREET S
Mailing Address - Street 2:STE 540
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701
Mailing Address - Country:US
Mailing Address - Phone:941-782-4299
Mailing Address - Fax:941-782-4301
Practice Address - Street 1:603 7TH STREET S
Practice Address - Street 2:STE 540
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701
Practice Address - Country:US
Practice Address - Phone:727-828-8400
Practice Address - Fax:727-828-8401
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9107889363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015538300Medicaid
FLHT994ZMedicare UPIN