Healthcare Provider Details

I. General information

NPI: 1013879170
Provider Name (Legal Business Name): KASEY BUBB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4113 SW 9TH AVE
CAPE CORAL FL
33914-5714
US

IV. Provider business mailing address

4113 SW 9TH AVE
CAPE CORAL FL
33914-5714
US

V. Phone/Fax

Practice location:
  • Phone: 914-391-7354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11043851
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: