Provider Demographics
NPI:1992715809
Name:NELSON-CASIMIR, ARETHA (MD)
Entity type:Individual
Prefix:
First Name:ARETHA
Middle Name:
Last Name:NELSON-CASIMIR
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 1:10081 PINES BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6171
Mailing Address - Country:US
Mailing Address - Phone:954-251-1175
Mailing Address - Fax:954-842-3332
Practice Address - Street 1:10081 PINES BLVD STE B
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6171
Practice Address - Country:US
Practice Address - Phone:954-251-1175
Practice Address - Fax:954-842-3332
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83063208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL262248300Medicaid
FLME83063OtherMEDICAL LISENCE