Krystal K Casanova Encarnacion, APRN.

Primary specialty

Critical Care Pediatric Nurse PractitionerTaxonomy code 363LP0222X

License

APRN11002846 Issued in FL

Practice address

16230 Summerlin Rd Ste 215
Fort Myers, FL 33908-5769

Phone

(239) 343-7474

Fax

(239) 343-4190

NPI assigned

Jun 20, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Krystal K Gordon Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kgordon271914@direct.leememorial.org
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.73767

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lee Health System Inc

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1942058557
  Medicare reassignment NPD
• Lee Memorial Health System

  • Internal Medicine Physician
  • Fort Myers, FL
  • NPI 1992873319
  Medicare reassignment NPD
• Lee Health System Inc

  • Community/Retail Pharmacy
  • Bonita Springs, FL
  • NPI 1699510925
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Port Charlotte, FL
  • NPI 1255171765
  NPD
• Lee Memorial Health System

  • Federally Qualified Health Center (FQHC)
  • Fort Myers, FL
  • NPI 1770165920
  NPD
• Family Health Centers of Southwest Florida

  • Dental Clinic/Center
  • Fort Myers, FL
  • NPI 1790166999
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739232000000",
    "number": "1568022523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2147",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339022147",
            "telephone_number": "239-424-1500",
            "fax_number": "239-424-1423"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16230 SUMMERLIN RD STE 215",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339085769",
            "telephone_number": "239-343-7474",
            "fax_number": "239-343-4190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4300 Kings Hwy Ste 500",
            "address_purpose": "LOCATION",
            "city": "Port Charlotte",
            "state": "FL",
            "postal_code": "339802953",
            "country_code": "US",
            "telephone_number": "844-342-7935",
            "fax_number": "941-764-6176",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "260 Beth Stacey Blvd # C",
            "address_purpose": "LOCATION",
            "city": "Lehigh Acres",
            "state": "FL",
            "postal_code": "339366074",
            "country_code": "US",
            "telephone_number": "239-343-9888",
            "fax_number": "239-303-0714",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CASANOVA ENCARNACION",
        "first_name": "KRYSTAL",
        "middle_name": "K",
        "credential": "APRN.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-20",
        "last_updated": "2025-02-11",
        "certification_date": "2025-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0222X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics, Critical Care",
            "state": "FL",
            "license": "APRN11002846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103687500",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kgordon271914@Direct.leememorial.org",
            "affiliation": "Y",
            "affiliationName": "Lee Memorial Health System",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2776 Cleveland Ave",
            "city": "Fort Myers",
            "state": "FL",
            "country_code": "US",
            "postal_code": "339015864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "KRYSTAL",
            "last_name": "GORDON",
            "middle_name": "K",
            "credential": "APRN.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Caru Care LLC
• Beth A Cary, LMT
• Sabreena Cary
• Madison Casale, PA
• Pasquale Casale, M.D.
• Kathyria Casanova-Feliciano
• Cascade Hand & Orthopedic Rehab, Inc.
• Carl Jerome Cascione, M.D.
• Kristin J Case, CRNA
• Dana Caserto, COTA

• Critical Care Pediatric Nurse Practitioner in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Critical Care Pediatric Nurse Practitioner in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.