MEDICARE: CASSANDRA JENNINGS LMT, LPN

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	164W00000X	Licensed Practical Nurse	PN1278991	FL
2	225700000X	Massage Therapist	MA54006	FL

General Provider Information

NPI Number	:	1518730142
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASSANDRA JENNINGS LMT, LPN

Provider Business Mailing Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:	904-260-4849

Provider Business Practice Location Address
First Line	:	6144 GAZEBO PARK PL S STE 101
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-1086
Country	:	US
Telephone Number	:	904-260-3011
Fax Number	:

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

Provider Enumeration Date	:	11/06/2023
Last Update Date	:	11/06/2023

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