Provider Demographics
NPI:1902515711
Name:CASALIS CALVO, AIDA GRISEL (NP)
Entity Type:Individual
Prefix:
First Name:AIDA
Middle Name:GRISEL
Last Name:CASALIS CALVO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 EVERGREEN CREEK CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-9046
Mailing Address - Country:US
Mailing Address - Phone:786-378-1608
Mailing Address - Fax:
Practice Address - Street 1:7924 EVERGREEN CREEK CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-9046
Practice Address - Country:US
Practice Address - Phone:786-378-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11023002363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily