Provider Demographics
NPI:1992366967
Name:CASOLA, JENNIFER (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CASOLA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9440
Mailing Address - Country:US
Mailing Address - Phone:525-135-9063
Mailing Address - Fax:352-513-4872
Practice Address - Street 1:2671 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9440
Practice Address - Country:US
Practice Address - Phone:352-513-5906
Practice Address - Fax:352-513-4872
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002865363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner