MEDICARE: JIMMY PETER CASSIS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP2642392	FL
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP 2642392	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	ID168Z	OTHER	FL	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508156357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JIMMY PETER CASSIS ARNP

Provider Business Mailing Address
First Line	:	5841 NE 21ST WAY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2524
Country	:	US
Telephone Number	:	954-530-8638
Fax Number	:

Provider Business Practice Location Address
First Line	:	404 SE 15TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33316-1942
Country	:	US
Telephone Number	:	954-530-8638
Fax Number	:	954-530-8638

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	03/03/2025

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