Provider Demographics
NPI:1164307740
Name:CASANOLA CHAVEZ, ODANAYZA (ARNP)
Entity type:Individual
Prefix:
First Name:ODANAYZA
Middle Name:
Last Name:CASANOLA CHAVEZ
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 LEROY AVE
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33972
Mailing Address - Country:US
Mailing Address - Phone:786-387-4239
Mailing Address - Fax:
Practice Address - Street 1:1406 LEROY AVE
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33972
Practice Address - Country:US
Practice Address - Phone:786-387-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-11
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11041348363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily