Provider Demographics
NPI:1447001060
Name:CASIMIR, OLIVIA A (PA-C)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:A
Last Name:CASIMIR
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 1:78 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-5510
Mailing Address - Country:US
Mailing Address - Phone:404-718-9514
Mailing Address - Fax:
Practice Address - Street 1:25 NEWELL RD STE E36
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5132
Practice Address - Country:US
Practice Address - Phone:860-583-9252
Practice Address - Fax:860-585-9848
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6773363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant